瘤段骨灭活回植术在骨干部恶性骨肿瘤保肢治疗中的应用

目的探讨瘤段骨灭活回植术治疗骨干部恶性骨肿瘤的实用性和疗效。方法自2007年9月至2010年11月，采用瘤段骨灭活回植的方法共治疗骨干部恶性骨肿瘤12例，男8例，女4例。年龄16-57岁，平均27．3岁。部位：肱骨2例，尺骨1例，桡骨1例，股骨4例，胫骨4例。病理类型：骨肉瘤3例，恶性纤维组织细胞瘤5例，软骨肉瘤2例，骨纤维肉瘤2例。所有患者术前经临床、影像学检查及病理活检明确诊断，并接收2个周期的规范化化疗。手术距骨肿瘤边缘上下5cm处截骨，将瘤段骨完整切除，剔除瘤段骨上的肿瘤组织及软组织并打通髓腔，然后用95％乙醇灭活30min，植骨或骨水泥填塞瘤段骨的骨缺损区，原位回植后用内固定物予以固定。术后2周开始进行4个周期的化疗。术后采用ISOLS系统对患者肢体功能进行评价。按时进行影像学检查观察骨愈合情况及有无肿瘤局部复发。结果本组12例患者均获得随访，随访时间15-53个月，平均32．6个月。其中1例恶性纤维组织细胞瘤患者于术后31个月因肺转移死亡，其余11例ISOLS评分为25～29分，平均26．5分。所有患者均获得骨性愈合，愈合时间6—11个月，平均愈合时间7．8个月。至末次随访时所有病例均无局部复发。结论瘤段骨灭活回植术具有费用低廉、操作易掌握等特点，结合新辅助化疗治疗骨干部恶性骨肿瘤疗效满意，目前仍然具有实用价值。

The application of inactivated tumor-bearing bone replantation in limb salvage surgery for diaphyseal malignant bone tumors

Objective To investigate the practicality and efficacy of the application of inactivated tumor- bearing bone replantation in limb salvage surgery for diaphyseal malignant bone tumors. Methods From September 2007 to November 2010, 12 patients with diaphyseal malignant bone tumors underwent the surgery of inactivated tumor-bearing bone replantation. There were 8 males and 4 females, with an average age of 27.3 years old （range; 16- 57 years）. The lesions located in the humerus （n=2）, the ulna （n=l）, the radius （n=l）, the femur （n=4）, and the tibia （n=4）. The pathological types were 3 cases of osteosarcoma, 5 cases of malignant fibrous histiocytoma, 2 cases of chondrosarcoma and 2 cases of fibrosarcoma of bone. All patients had 2 periods of standard chemotherapy, after the definite diagnosis was determined preoperatively through the clinical and imaging examination and biopsy. The tumor- bearing bone was cut at the point of 5cm away from the tumors, and then was completely resected. The lesions and soft tissues were cleared, with the medullary cavity drilled through, and then were inactivated for 30 minutes in alcohol. The defects were filled with bone grafts or bone cements. The tumor-bearing bone was replanted to their original position and was fixed with internal fixators. 2 weeks after surgery, all patients began to have 4 periods of chemotherapy. The patients＇ limb functions were evaluated by the International Society of Limb Salvage （ISOLS） postoperatively. All patients had the imaging examination on time to show the bone union and local tumor recurrence. Results All patients were followed up for an average period of 32.6 months （range; 15-53 months）. 1 patient with malignant fibrous histiocytoma died 31 months after surgery due to the lung metastases. The left 11 cases＇ ISOLS scores ranged from 25 to 29 points, with a mean score of 26.5 points. All cases showed bone union. The average healing time was 7.8 months （range; 6-11 months）. There was no case with local tumor recurrence in the latest follow-up. Conclusions The surgery of inactivated tumor-bearing bone replantation has the characteristics of inexpensive cost, being easy to grasp and so on. When combined with the neoadjuvant chemotherapy, the efficacy of the surgery in treating diaphyseal malignant bone tumors is satisfactory. The surgery still has practical value at present.