Hand function following single ray amputation

We retrospectively studied primary and reconstructive single ray resection at 16 to 150 months after surgery (median, 41 months) in 25 patients (18 males) whose average age was 28 years. Cases were reviewed 16 to 154 months after surgery (median, 41 months). The injuries involved 14 dominant and 11 nondominant hands. Twelve patients had primary ray resection (< or =2 weeks after injury) and 13 had secondary/reconstructive amputation of 18 border and 7 central digits. Examinations and functional testing by Minnesota rate of manipulation and timed grooved pegboard tests were done and x-rays were reviewed. The majority of patients were subjectively satisfied with the appearance and function of the hand. Patients lost an average of 13 weeks of work (range, 2-24 weeks); those with primary resection were out of work 9 weeks (range, 2-17 weeks) and patients who had secondary resection lost a total of 16 weeks of work (range, 7-24 weeks). Twenty-one of the 25 patients returned to their preinjury occupation. Evaluation of nonwork plus settled workers' compensation cases versus nonsettled compensation/litigation cases showed that there were statistically significant differences in grip strength, key pinch, oppositional pinch, and Minnesota rate of manipulation test results. Primary ray removal limits the total costs associated with injury and disability; unsettled compensation/litigation issues produce statistically disparate and otherwise physically inexplicable differences.     

Functional and cosmetic outcome of single-digit ray amputation in hand

Purpose

To assess patient satisfaction, functional and cosmetic outcomes of single-digit ray amputation in hand and identify factors that might affect the outcome.

Methods

Forty-five patients who underwent ray amputation were evaluated, 37 males and eight females whose mean age was 36.6 years ranging between 15 and 67 years. Twenty-eight patients had dominant hand involvement. Twenty-one patients underwent primary ray amputation, and 24 patients had secondary ray amputation. Eight out of the 23 patients with central digit injuries underwent transposition. Grip strength, pinch strength, tactile sensibility and functional evaluation using Result Assessment Scale (RAS) and DASH score were analysed. Cosmetic assessment was performed using visual analogue scale (VAS) for cosmesis.

Results

Median time of assessment after surgery was 20 months. Average loss of grip strength and pinch strength was found to be 43.3 and 33.6%, respectively. Average RAS score was 3.75. Median DASH score was 23.4. Eighty-three percentage of patients had excellent or good cosmesis on the VAS. Transposition causes significant increase in DASH scores for central digit ray amputations but was cosmetically superior. Middle finger ray amputation had the maximum loss of grip strength, and index finger ray amputation had greater loss of pinch strength. Affection of neighbouring digits caused greater grip and pinch loss, and a higher DASH score. Primary ray resection decreased the total disability and eliminated the costs of a second procedure.

Conclusion

Following ray amputation, one can predict an approximate 43.3% loss of grip strength and 33.6% loss of pinch strength. The patients can be counselled regarding the expected time off from work, amount of disability and complications after a single-digit ray amputation. Majority of the patients can return to the same occupation after a period of dedicated hand therapy.

Level of Evidence

Therapeutic, Level III.

     

Measurement of maximum voluntary pinch strength: effects of forearm position and outcome score.

The purpose of this study was to determine the effects of forearm position and outcome score on key, fingertip, and three-jaw chuck pinch strength. Maximum voluntary key, fingertip, and three-jaw chuck pinches were performed by 135 healthy adults (20-88 years old) three times in a pronated, supinated, and neutral forearm position with the right and left hand using a B&L (B&L Engineering, Tustin, CA) pinch gauge. The highest, first, and mean scores of three pinch forces were recorded. Three 3 x 3 factorial repeated-measures analyses tested each type of pinch strength. Forearm position affected key and fingertip pinches (p<0.017; effect sizes <0.14) but not three-jaw chuck pinch. The highest score ranked highest followed by the first and then the mean of the three scores (p<0.017; effect sizes >0.53). Although the effects of type of outcome score were consistent, the statistically significant effects of forearm position and outcome score may be too small (<1 lb) to be clinically relevant. Standardized positioning during pinch strength measurement is still recommended despite these findings.     

Single Ray Amputation for Tumors of the Hand

Single ray amputation after hand trauma or infection can result in good aesthetic and functional outcomes. The role of this procedure in the management of aggressive benign or malignant hand tumors has been described only in case reports and small case series. We retrospectively reviewed the records of all 25 patients who underwent single ray amputations at our center during a 10-year period; there were seven index, five middle, six ring, and seven small ray amputations performed. The minimum followup was 2 months (mean, 36 months; range, 2–120 months), with four patients having a followup of 1 year or less. No patients had local recurrences, although two patients had positive resection margins. One underwent repeat resection followed by radiotherapy. The other was treated with radiotherapy alone, as local tumor control would have required a hand amputation. Functional assessment based on the Musculoskeletal Tumor Society staging system showed an average of 27.5 (range, 21–30). Patients who underwent perioperative radiotherapy experienced a decrease in functional ability. Grip strength was an average of 66% (range, 38%–100%) of the contralateral side. Our study suggests single ray amputation for hand tumors has a low local recurrence rate and high functional scores. However, function can be compromised by radiotherapy and a decrease in grip strength by a mean of 34% is to be expected.     

Primary ray resection as an alternative to microsurgical replantation in the management of ring finger avulsion

ObjectivesRay resection of the metacarpal with conservation of the proximal end is a technique of management of complete ring avulsion injuries in the emergency situation. This study is a functional evaluation of the technique in comparison to replantation.MethodsThe present series includes 11 patients, average age of 35 years, predominantly manual workers, operated between October 2005 and July 2007. It consisted of two grades IVA, six grades IVB, and three grades IVC (classification of Merle–Michon). Cases were assessed according to grip and pinch strength, quantitative 400 points score and a work evaluation.ResultsTen patients were evaluated with an average follow-up of nine months (range: three to 19 months). There were no complications apart from four patients with phantom pain. The time to return to work was three months (range: 10–219 days). All patients were satisfied with the cosmetic appearance, however eight of them suffered from psychological problems, finding it difficult to accept a four-fingered hand. Secondary surgery was unnecessary in the majority of the patients (80%). The grip strength was measured as 30% of grip strength of the unaffected side (range: 3–70%). The result of the 400 point score was 75,94% (range: 55–99%).ConclusionRay resection of the metacarpal with conservation of the proximal end is a reliable procedure. Strength is decreased but this does not stand in the way of a rapid return to previous work. However, the choice of strategy (ray resection versus microsurgical replantation) should be discussed in detail with the patient prior to selecting the appropriate option.     

One hundred eleven thumb amputations: replantation vs revision

One hundred eleven patients who sustained isolated, complete thumb amputation between 1971 and 1985 were reviewed to assess results of replantation and to compare these with results of amputation revision. Routine postoperative evaluation was performed in 69 successful replant patients and in 42 with revision. Twenty-five of the replant group and 18 of the revision group returned for additional testing that consisted of interview and physical examination, test of activities of daily living, Jebsen test of hand function, and both static and dynamic testing on the BTE work simulator. Ninety percent of replantations were between the metacarpophalangeal (MCP) joint and the proximal third of the distal phalanx. Shortening averaged 11 mm, and range of motion was 42% +/- 28% that of the uninjured thumb. One-half of the patients could touch the MP of their ring finger, and one-fourth could touch the proximal interphalangeal (PIP) joint. Twenty-one percent had 7 mm or less two-point discrimination, and 38% had between 8 and 20 mm. Eighty percent of both groups were able to perform activities of daily living at 80% of their uninjured side. Grip strength was approximately 84% of that of the uninjured hand in each group. Lateral pinch averaged 68% +/- 26% of that of the normal side in the replant group and 91% + 9% in the amputation group. Work simulator assessment of lateral and three-point pinch was better in the revision group. Scores on Jebsen testing were slightly better for those with replanted thumbs, but in general neither replant nor revision patients functioned as well as did Jebsen's normals.(ABSTRACT TRUNCATED AT 250 WORDS)     

Basal thumb metacarpal osteotomy for trapeziometacarpal osteoarthritis

PURPOSE: To review the subjective and functional results of basal thumb metacarpal osteotomy for the treatment of trapeziometacarpal osteoarthritis. METHODS: Between July 1993 and November 1998, 35 thumb osteotomies without internal fixation were performed on 33 patients in the Christchurch Hospital, New Zealand. Records of 28 thumbs (13 right and 15 left) of 26 patients (17 women and 9 men) were available for review. Patients were reviewed using strength testing and the Michigan Hand Outcomes Questionnaire. RESULTS: The mean age of the 26 patients was 54 years (range, 30-69 years). Of the 28 thumbs, 22 (21 patients) had good or excellent results, 2 fair, one poor. The remaining 3 thumbs (3 patients) required further revision and were classified as failures. The mean follow-up period of the 25 thumbs (24 patients) not requiring revision was 34 months (range, 12-73 months). Good thumb motion was present in all hands with no trapeziometacarpal instability seen. Compared with the normative data, the strengths of key pinch, pulp pinch, and tripod pinch of our patients were significantly lower (22-32% lower), but not the grip strength. Michigan Hand Outcomes Questionnaire scores increased 28 (range, 1-56) points after surgery, with significant improvement especially in pain (+44 points), activities of daily living (one-handed tasks, +41 points), and satisfaction (+35 points). CONCLUSION: Basal thumb metacarpal osteotomy is a straightforward, conservative procedure that should be considered for grades II and III trapeziometacarpal osteoarthritis.     

Functionality of middle-aged women after resection–interposition arthroplasty of the trapeziometacarpal joint in comparison to a healthy control group

Introduction

Trapeziometacarpal joint osteoarthritis is a very common degenerative joint disease which affects especially women between their fifth and sixth decade of life. To determine the final pinch, grip and functional outcome after trapeziometacarpal arthroplasty and to compare to non-arthritic controls, we hypothesized that patients after the former surgery are expected to have lower grip and pinch strength and a higher DASH score.

Materials and methods

44 women (range 50–65 years of age; median 57 years of age) were examined after resection–interposition arthroplasty because of trapeziometacarpal joint osteoarthritis Eaton–Littler stage 3 and 4 with a minimum follow-up time of 12 months (range 12–99 months; median 47 months) using DASH questionnaire and grip and pinch strength evaluation. The control group consisted of 107 healthy age-matched controls (range 50–64 years of age; median 54 years of age). Differences between both groups were statistically analysed using analysis of covariance.

Results

A significant loss of pinch strength and a significant higher DASH score were detected for the patient group in comparison to the controls, whereas grip strength did not differ significantly.

Conclusions

A loss of pinch strength in conjunction with a higher DASH score was detected. The expected loss of pinch strength in conjunction with a reduced physical functionality should be discussed preoperatively with the patient to meet the expectations and to offer the best suitable treatment option.     

Comparison of Swanson and Sutter metacarpophalangeal arthroplasties in patients with rheumatoid arthritis: a prospective and randomized trial

PURPOSE: To perform a prospective and randomized comparison of the clinical outcome of patients with rheumatoid arthritis who had Swanson or Sutter implant replacement arthroplasty of the metacarpophalangeal joints. METHODS: There were 45 patients (3 men, 42 women) and 49 hands; a total of 75 Swanson and 99 Sutter implants were inserted. The mean time between surgery and the final follow-up control visit was 58 months (range, 37-80 mo). Preoperative and postoperative measurements were performed including active extension and flexion, correction of ulnar deviation, and strength. RESULTS: There was no statistically significant difference between groups with regard to active extension deficit correction. Mean active flexion decreased less in the Sutter group than in the Swanson group but difference between the groups was statistically significant in only the index finger. At the final follow-up examination no significant differences existed between the groups in the correction of ulnar deviation or arc of motion. Grip strengths, chuck pinch, and thump-to-fingertip grip strengths did not improve in either of the groups. CONCLUSIONS: In this study clinical results showed no significant difference between the groups with the single exception of the amount of index finger metacarpophalangeal joint flexion.     

Concomitant endoscopic carpal and cubital tunnel release: safety and efficacy

Background

When performed alone, endoscopic carpal tunnel release and endoscopic cubital tunnel release are safe and effective surgical options for the treatment of carpal and cubital tunnel syndromes, respectively. However, there is currently no literature that describes the performance of both procedures concomitantly. We describe the results of 17 cases in which dual endoscopic carpal and cubital tunnel releases were performed for the treatment of concurrent carpal and cubital tunnel syndromes.

Methods

A retrospective review of all patients in a single surgeon practice that presented with concomitant ipsilateral carpal and cubital tunnel syndromes was performed. Within an 8-month period, 17 patients had undergone 19 concomitant ipsilateral endoscopic carpal and cubital tunnel releases after failing conservative treatment. Pre- and postoperative measurements included subjective numbness/tingling; subjective pain; manual muscle testing of the abductor pollicis brevis (APB), intrinsics, and flexor digitorum profundus (FDP); static two-point discrimination; quick-DASH (Disabilities of the Arm, Shoulder and Hand) scores; grip strength; chuck pinch strength; and key pinch strength. Complete data are available for 15 patients and 17 total procedures.

Results

Thirteen male and four female patients (average age of 50.5) underwent dual endoscopic cubital and carpal tunnel release. Two patients were lost to follow-up and eliminated from data analysis. Pre- and postoperative comparisons were completed for median DASH scores, grip strength, chuck pinch strength, and key pinch strength at their preoperative visit and at 12 weeks. DASH scores improved significantly from a median of 67.5 to 16 (p?=?0.002), grip strengths improved from 42 to 55.0 lbs (p?=?0.30), chuck pinch strengths improved significantly from 11 to 15.5 lbs (p?=?0.02), and key pinch strengths increased significantly from 13 to 18 lbs (p?=?0.003). Average static two-point discrimination decreased from 5.9 to 4.8 mm. In terms of pain, 82 % of patients had complete resolution of pain, and the remaining 18 % experienced pain only with strenuous activity. In terms of numbness/tingling, 100 % of patients had complete resolution of median nerve symptoms; 88 % of patients had substantial improvement of numbness and tingling symptoms, and 12 % had residual ulnar nerve symptoms. In terms of muscle strength, 92 % of patients had improvement to 5/5 APB strength, while 100 % of patients had improvement to 5/5 intrinsic and FDP strengths. Two minor complications occurred, including one superficial hematoma and one superficial cellulitis.

Conclusions

Preliminary data demonstrate that dual endoscopic carpal and cubital tunnel release is a safe and effective treatment option for patients who present with concurrent cubital and carpal tunnel syndromes recalcitrant to non-surgical management. Postoperative results and complications are comparable to endoscopic carpal and cubital tunnel releases performed alone.     

Rare site giant cell tumors: report of two cases on phalanges of the finger and review of literature

Giant cell tumor (GCT) of bone arising from a phalanx of a finger is extremely rare. We report two cases of GCT arising from a phalanx of a finger. One case presented with recurrence following the amputation of the left ring finger (performed elsewhere). He was treated successfully with ray amputation. The other case was treated primarily by intralesional curettage and autogenous bone graft. At their most recent follow-ups (80 and 24 months, respectively), both were recurrence free and had returned to their previous occupational and recreational activities.     

Results of secondary single ray resection without transposition of an adjacent digit

In this study, we retrospectively reviewed and analysed results of secondary single ray resection in ten patients (eight males and two females) whose average age was 40.5 years (range, 27–64 years). The mean time for surgery after initial injury was 34.5 months (range, 1–300 months). There were seven manual workers, two intellectual workers, and one student. Cases were reviewed 3–12 years after surgery (median, 6 years). Nine patients were right-handed and one was left-handed. The injuries involved five dominant hands (50%) and five nondominant hands. Lesions touched preferably border digits in eight cases (seven index and one fifth), and central digits in two cases (one long and one ring). Patients had an average total time off from work of 5.1 months (range, 3–8 months), and an average time of 2.4 months (1–4 months) if considered only the post-operative period after ray resection. The patients were all re-evaluated questionnaires, physical examination, and functional testing. Seven of the ten patients (70%) returned to their pre-injury activity. On the whole, seven results have been considered as excellent; two as good and one as medium. However, despite these good results and in order to decrease the long time period lost off work, to avoid disability and high social cost, we believe that primary ray resection could be proposed to patients in some elective cases as an alternative choice for a better result, taking into consideration certain decisional factors particularly age, sex, occupation, dominant hand, severity of injuries, as well as the advantages and inconveniences of primary or secondary ray resection.     

Ring finger ray amputation: a 25-year follow-up.

The treatment of class III ring avulsion injuries remains controversial. This case report presents a 25-year follow-up of a class III ring avulsion injury treated with secondary ring finger ray amputation. This case shows long-term excellent functional and cosmetic results of ring finger ray resection without bony transposition.     

Simultaneous powering of forearm pronation and key pinch in tetraplegia using a single muscle-tendon unit

This study clinically assessed the concept that both thumb flexion and forearm pronation can be restored by brachioradialis (BR)-to-flexor pollicis longus (FPL) tendon transfer if the BR is passed dorsal to the radius. Six patients [two women and four men, mean age 32.3 years (SD 4.9, range 23-56)] underwent BR-to-FPL transfer dorsal to the radius and through the interosseous membrane (IOM). Lateral key pinch strength and pronation range of motion (ROM) were measured 1 year after surgery. A group of six patients [two women and four men, mean age 31.2 years (SD 5.0, range 19-52)] who underwent traditional palmar BR-to-FPL was included for comparison. Postoperative active pronation was significantly greater in the dorsal transfer group compared to the palmar group [149 (SD 6) and 75 (SD 3), respectively] and pinch strength was similar in the two groups [1.28 (SD 0.16) kg and 1.20 (SD0.21) kg, respectively]. We conclude that it is feasible to reconstruct lateral key pinch and forearm pronation simultaneously using only the BR motor.     

Trapeziometacarpal arthroplasty using the entire flexor carpi radialis tendon

Fifty-eight patients (62 joints) with arthritis of the thumb carpometacarpal joint were treated with resection arthroplasty, ligament reconstruction, and tendon interposition with the entire flexor carpi radialis tendon. The mean age of the patients at the time of surgery was 58.4 years (range, 28-80 years), and the average followup was 42.5 months (range, 21-86 months). The entire flexor carpi radialis tendon was used for reconstruction and interposition. In 32 of the 62 joints, a partial trapezoidectomy was performed for scaphotrapezoidal arthritis. Finger-tip pinch improved by 88%, key pinch improved by 86%, and grip strength improved by 69%. Palmar and radial abduction also improved by 8% and 10%, respectively. Fifty-five (95%) patients reported excellent pain relief, whereas three patients reported only mild pain. No patients experienced an increase in pain. All thumbs were stable radiographically. This study indicated ligament reconstruction with tendon interposition, accompanied by partial trapezoidectomy when indicated, provides excellent pain relief and restoration of function. No morbidity was observed with use of the entire flexor carpi radialis tendon.     

Functional outcome after the Moberg advancement flap in the thumb.

A Moberg palmar advancement flap was performed for pulp reconstruction of the thumb in 36 cases. No flap was lost. Eighty-three percent of the defects were closed without additional iatrogenic bony shortening of the thumb. Sensory testing showed normal sensitivity in 74% of the 25 patients studied at a mean of 27 months. Minor restrictions in the active range of motion in the interphalangeal joint were mainly attributable to a loss of hyperextension. No thumb showed a permanent flexion contracture. The flap alone did not result in a reduction in grip strength, but an additional bony amputation resulted in decreased strength of 3-point pinch grip. Seventy-two percent of the patients had no or only mild subjective complaints. The Disabilities of the Arm, Shoulder, and Hand questionnaire, which was used for the first time as a standardized measure to assess functional outcome after this procedure, showed only minor impairment levels (12.4 +/-). Based on these data, the Moberg advancement flap remains the procedure of choice for covering defects of the distal palmar thumb.     

Restoration of active palmar abduction of the thumb in tetraplegia by tendon transfer of the extensor digiti minimi to abductor pollicis brevis

We describe a method to restore active palmar abduction of the thumb and report its functional impact in tetraplegia. At 54.2 (SD 42.8) months after cervical spinal cord injury (12 traumatic, 3 nontraumatic), the extensor digiti minimi (EDM) tendon was transferred to the abductor pollicis brevis (APB) through the interosseous membrane in 15 tetraplegic patients (age range 19-70 years) in addition to a mean 3.2 procedures to restore key pinch. According to International Classification, the operated upper extremities were in the OCu4 to OCu8 (1 patient X) group. The maximum distance between thumb and index finger tips during active or passive opening of the hand, maximum angle of palmar abduction, grip and key pinch strength, and active finger range of motion were measured. All patients were re-examined after 38.4 (SD 22.7) months. The active thumb-index opening increased significantly from 2.5 (SEM 1.0) cm before to 9.0 (SEM 0.8) cm after surgery. Nine patients without previous active opening of the first web space recovered a mean thumb-index opening of 9.1 (SEM 1.7) cm, whereas this distance increased by an average of 2.9 (SEM 0.8) cm in six patients who had active thumb index distance of 6.3 (SEM 1.6) cm before surgery. All but one patient were able to direct and coordinate key pinch and perform tasks using the restored APB function, including five patients whose EDM strength was rated as grade 3 before transfer. This EDM-to-APB transfer meets the theoretical requirements of architecture matching between donor and recipient muscles, the principles of tendon transfer, and our surgical expectations. We strongly recommend that an active EDM is transferred to the APB to restore opening of the hand and help in key pinch control in patients with tetraplegia.     

Osteosynthetisch versorgte intraartikuläre Frakturen der Metakarpale-I-Basis

BACKGROUND: Fractures of the thumb metacarpal occur quite frequently at the base. Intra-articular metacarpal base fractures (such as Bennett or Rolando fractures) present treatment challenges and surgical therapy remains controversial. Malunion of these fractures may lead to the development of painful osteoarthrosis at the trapeziometacarpal joint which can seriously impair overall hand function. PATIENTS AND METHODS: In a retrospective analysis, 30 intra-articular fractures (24 Bennett's, three Rolando's and three comminuted fractures) treated between 1994 and 1999 in the Department of Hand, Plastic and Reconstructive Surgery in Ludwigshafen have been reviewed. A total of 25 patients (83%) could be examined clinically and radiologically at an average follow-up of 39 months. The subjective outcome was measured using the DASH-questionnaire. Clinical examination included grip strength and range of motion measurements. RESULTS: Four cases were treated with percutaneous pinning, in 26 cases open reduction with internal fixation was performed. Radiological analysis demonstrated good reduction in 90% of all cases (metacarpal base gap/step-off in articular surface: <1 mm in 63%, between 1-2 mm in 27%, >2 mm in 10%). Twelve patients (48%) were free of symptoms at follow-up. Slight restricted flexion was noted in 11 (44%) patients (75-90% of healthy collateral values), including one patient with moderate opposition deficit (<75% of uninjured value). Three patients (12%) demonstrated weakness in tip pinch and one patient had decreased key pinch compared to the uninjured hand. Overall, good functional results for radial abduction, flexion and opposition as well as good grip strength compared to their uninjured side were found. At follow-up a total of 64% radiological features of trapeziometacarpal arthrosis have been documented. Very low impairment rates in the DASH-scores of all three parts (below 9 points) were measured. There was no correlation between the quality of thumb base restoration and radiological or subjective outcome. CONCLUSION: Exact anatomical restoration of the articular surface may not be essential for obtaining satisfactory functional results.     

Results following trapeziometacarpal arthroplasty of the thumb.

A retrospective follow-up study was performed on patients with degenerative joint disease (DJD) who underwent trapeziometacarpal arthroplasty of the thumb with 3-week immobilization and without the use of K-wire fixation. Pre- and post-operative pain, activities of daily living (ADLs), grip strength, and pinch strength were compared. Data were collected on 25 hands in 23 patients, 7 hands with full trapezium resections and 18 with hemi-trapezium resections. The median age was 60 years, with a range of 39 to 73 years, and the median follow-up period was 1 year 11 months, with a range of 3 months to 11 years. Grip and pinch strength were measured pre- and postoperatively. Pain was assessed on a visual analog scale (VAS), and ADLs were assessed by means of a 15-item survey. Both pain and ADLs were evaluated postoperatively with recall of preoperative status. Following surgery, all thumbs were immobilized in a static splint for 3 weeks and then allowed progressive use. Median improvements in hemi-trapezium resections included grip, 22.5 lb; pinch, 4.7 lb; and ADLs, 33%. Pain was reduced a median of 7.0 cm on the VAS. Median improvements in full trapezium resection included grip, 29.5 lb; pinch, 0 lb; ADLs, 60%; and pain reduction, 8 cm on the VAS. This follow-up study suggests that satisfactory results can be achieved in pain reduction, strength, and ADLs with an immobilization period of only 3 weeks and without the use of K-wires following carpometacarpal (CMC) arthroplasty.     

老年骨肉瘤10例治疗总结

目的探讨老年骨肉瘤（≥60岁）的临床特点和治疗效果。 方法回顾性分析2007年1月至2017年3月期间山东大学齐鲁医院骨科收治的≥60岁的骨肉瘤患者10例,女性8例,男性2例,年龄60~76岁,平均（66±6）岁,病变位于股骨5例、踝关节软组织1例、多中心1例、骨盆（Ⅲ区）1例、肱骨1例、距骨1例。确诊后行截肢术2例,截肢术结合化疗2例,广泛切除术1例,广泛切除术结合化疗3例,边缘切除结合放疗1例,单纯化疗1例。 结果10例患者中,4例就诊时病史已超过6个月,2例就诊时已出现肺转移,5例合并基础疾病,2例血清ALP水平升高（>125 U/L）。影像学方面,7例为混合型,1例为溶骨型,1例为成骨型,1例位于软组织。肿瘤组织类型方面,普通型骨肉瘤7例,骨旁骨肉瘤2例,髓内高分化性骨肉瘤1例。10例患者随访3.5~124个月,平均（40±37）个月。1例接受单纯化疗的肺转移患者于明确诊断后3.5个月死亡,另1例肺转移患者接受转移灶射频消融术,随访58个月带瘤生存,1例距骨骨肉瘤复发后行截肢术。其余7例均未出现肿瘤复发或远处转移。 结论老年骨肉瘤临床较为少见,具有不同于青少年骨肉瘤的临床特点和预后,应早期明确诊断,采取适合患者自身情况的治疗方法,以尽可能降低复发和转移的发生率,延长生存期。