四肢、躯干恶性肿瘤的术腔加热化疗研究

自１９８９年１月至１９９６年１月,作者应用手术腔加热灌注化疗四肢,躯干恶性肿瘤７１例,其中恶性（Ⅲ级）骨巨细胞瘤２６例,恶性骨母细胞瘤３例,恶性成软骨细胞瘤１例,骨肉瘤１４例,软骨肉瘤７例,尤文氏肉瘤２例,纤维肉瘤２例,滑膜肉瘤８例,神经纤维肉瘤２例,恶性纤维组织细胞瘤５例,血管肉瘤１例。手术腔内加热温度４３℃～４５℃,顺铂２００ｍｇ。加热时间６０分钟。获访６８例,结果复发率为５．７％,转移率为１４．７％,死亡率为１６％,生存率为８４％,５年生存率为７１．４３％。作者认为,术中加热化疗对防止或减少非早期转移肿瘤的局部复发和转移是有明显效果的,对早期即发生转移的肿瘤来说,同样可以减少因肿瘤细胞残留所引起的术后复发和转移,而对术前已发生转移的病灶则无作用。     

原发性肠系膜肿瘤43例分析

报告原发于肠系膜的肿瘤４３例。恶性２５例，良性１８例。均经手术治疗。除１例平滑肌肉瘤术中死于室颤外，余４２例均随访，良性肿瘤２例术后２年失访，余５年生存率为１００％；恶性肿瘤１年生存率为１６％，余均在３年内死亡。就原发性肠系膜肿瘤的一般特点、诊断和治疗进行了探讨。     

保肢术结合辅助化疗治疗肢体ⅡB期骨肉瘤

目的 评价保肢术结合辅助化疗治疗肢体ⅡＢ期骨肉瘤的临床疗效。方法 选择１９８９年６月￣１９９６年６保肢手术结合辅助化疗治疗肢体ⅡＢ期骨肉瘤患３５例,男２５例,女１０例;年龄１５￣３６岁,平均２０．３４岁。发病部位：股骨下端２２例,胫骨上端７例,肱骨上端３例,腓骨上端２例和股骨上端１例。３５例中达到广泛切除２０例,而仅达边缘切除１５例。３例肱骨上端病例行Ｔｉｋｈｏｆｆ－Ｌｉｎｂｅｒｇ手术;２例腓骨     

股骨干骨折内固定失效31例原因分析

本院自１９９１年１月以来，共收治股骨干骨折内固定失效３１例，原因分析如下。临床资料１．一般资料：本组男２５例，女６例；年龄１１～６７岁，平均３７．６岁。股骨干骨折原因：车祸２６例，坠落伤３例，摔伤１例，重物压击伤１例。闭合性骨折２６例，开放性骨折５例。内固定失效时间为１０天至１０．５个月，平均４．５个月。扶拐行走时摔倒者７例，其余均否认有暴力伤。原内固定术后开始不负重行走时间为１个月～３．５个月，平均２．５个月。院内手术１６例，院外手术１５例。骨折部位：股骨上１／３段１０例，中１／３段１５例，下…     

下肢恶性骨肿瘤保肢治疗51例

自１９７７～１９９７年我科收治下肢恶性骨肿瘤１０４例,其中保肢５１例。男３３例,女１８例。平均年龄３７岁。骨肉瘤１８例、恶性纤维组织细胞瘤２例、骨纤维肉瘤３例、软骨肉瘤８例、皮质旁骨肉瘤１例、横纹肌肉瘤１例、骨巨细胞瘤（Ⅱ～Ⅲ级）１６例、转移癌２例。ⅠＡ５例,ⅠＢ１８例,ⅡＡ６例,ⅡＢ２９例。手术分切刮加骨水泥、肿瘤切除加人工关节、假体置换、肿瘤段切除灭活再植、肿瘤切除异体半关节移植、单纯介入治疗。随防４６例,平均５８年,２年无瘤生存３８例,达８２６％,局部复发９例,占１９５％。死亡１８例,５年生存率达６４７％。所有病例术前均采用全身大剂量化疗或介入治疗。作者认为手术切除彻底,一般切到正常组织内２ｃｍ～５ｃｍ,术后继续化疗对防止肿瘤局部复发是可能的。对肿瘤侵犯广泛,手术难以彻底,或肢体功能丧失者,为防复发还是以截肢术为妥。对不同肿瘤采取不同的保肢方法,术后辅以综合治疗,可提高生存率     

胃癌R2,R3手术疗效的对比观察及评价

我们比较了胃癌Ｒ＿２、Ｒ＿３术后的近、远期疗效，并以病期和病理生物学行为为依据，探讨了合理选择两种手术的适应证。结果表明：Ｒ＿３术后１、３、５、７、１０年生存率均高于Ｒ＿２，以１、３、５年为著，与进行期病例（占８７％）有关。ＴＮＭⅠ期（Ⅰａ、Ⅰｂ）、Ｒ＿２、Ｒ＿３术后５年生存率基本相同，Ｒ＿２即可根治。Ⅱ、Ⅲａ期，Ｒ＿３优于Ｒ＿２。Ⅲｂ、Ⅳ期者，Ｒ＿３仍比Ｒ＿２提高，５年生存率２５．５％。早期癌及ＢｏｒｒｍａｎｎⅠ、Ⅱ型者两组相似，Ｒ＿３对ＢｏｒｒｍａｎｎⅢ和限局性ＢｏｒｒｍａｎｎⅣ型可提高疗效。Ⅰａ、Ⅰｂ期的胃壁内癌，淋巴结转移限于第一站者，Ｒ＿２可达到根治；Ⅱ期以上浸透浆膜含，Ｒ＿３可提高５年生存率。病理学的弥漫性生长方式、未分化癌及淋巴管癌栓者，生物学行为较差。对进行期病例应选择Ｒ＿３扩大根治术。Ｒ＿２、Ｒ＿３术后康复时间、并发症及死亡率主要与胃切除术式有关，与淋巴结清除范围无明显关系。     

33例复发性腹膜后肉瘤的治疗及其预后

目的探讨复发性腹膜后肉瘤的治疗方法及其预后。方法回顾性分析１９７２年～１９９６年收治的３３例复发性腹膜后肉瘤的临床资料。结果１７例（５１５％）患者在首次复发时完整切除肿瘤;２、３、１例患者分别在首次、２次和３次复发时进行联合脏器切除。共１４例患者术后接受不同剂量的放疗和化疗。对２９例患者进行６个月至１２年的随访,其中１５例（５１７％）死亡,７例生存５年以上,２例生存１０年以上。１、３、５年生存率分别为８５７％,５４９％和４２３％。结论外科手术切除肿瘤是提高复发性肉瘤生存率最重要的手段,联合脏器切除能提高肿瘤完整切除率,对多次复发的肿瘤不应放弃手术机会,放疗和化疗对复发性肉瘤可起一定的控制作用。病理类型为高分化脂肪肉瘤者,预后优于患其他类型肉瘤者     

顺铂高温灌注治疗骨肉瘤时肿瘤坏死率的相关研究

目的 探讨顺铂高温隔离肢体灌注（ＨＩＬＰ）治疗肢体骨肉瘤时肿瘤细胞坏死率与患肢血顺铂浓度、肿瘤内温度以及最终无瘤生存率间的关系。方法 １５例下肢ⅡＢ期骨肉瘤患者,男性１０例,女性５例;年龄１３～２９岁,中位年龄１８岁; 接受包括一次顺铂高温隔离灌注（顺铂剂量１５０ｍｇ／ｍ＾２）在内的新辅助化疗。手术方法：９例行保肢术,６例行截肢手术。所有切除标本均以多切片作肿瘤细胞坏死率评估。结果 １５例患者在Ｈ     

骨肉瘤患者的保留患肢治疗60例报告

１９７４年１月－１９９３年１２月，作者共收治骨肉瘤患者１０４例，其中６０例行保留患肢治疗，术式采用肿瘤大块切除，其中行人工关节置换者５４例，血管吻合自体腓骨移植者３例，肿瘤局部切除者３例。施行大剂量综合化疗４８例，其中ⅡＢ期骨肉瘤４４例，５年生存率为４４．６９％。总的局部发生率为１５％，感染率为１２．９％，人工关节机械合并症为１４．８％，人工关节功能良好率为６４．８１％。今后努力的方向是提高生存率     

40例胸腺肿瘤合并重症肌无力的手术治疗

报告４０例胸腺肿瘤合并重症肌无力（ＭＧ）的手术治疗效果。本组包括完全切除肿瘤和胸腺２６例，次全切除肿瘤１０例，组织活检４例。结果手术死亡１例（２．５％），术后１年内死亡８例（２０．５％）。３１例术后随访３～１２年，５年生存率为６１．３％，１０年生存率２７．７％；其中非浸润型胸腺瘤分别为７６．９％和３０．０％，浸润型胸腺瘤则为５０．０％和２５．０％。ＭＧ术后缓解改善率为８０．６％，术后肌无力危象发生率为４０．０％，抢救成功率为９３．８％，结论显示手术治疗胸腺肿瘤合并ＭＧ，如严格掌握手术指征，可获得较好的疗效和预后。     

人工全股骨关节置换治疗股骨骨肉瘤

目的探讨全股骨人工关节置换术治疗股骨骨肉瘤的适应证和并发症,评估术后功能结果。方法1996年10月至2002年10月,采用全股骨人工关节置换术治疗骨肉瘤患者17例,其中男性8例,女性9例,年龄12～34岁,平均16岁;发病部位于股骨上段1例,股骨下段6例,股骨干10例;ⅡB期患者12例,ⅢB期5例;病灶范围23～28cm,有跳跃灶3例,病理骨折2例;术前均行病灶活检,明确诊断。17例行术前化疗,15例术后化疗。手术经患肢外侧入路,人工全股骨假体置换。按照MSTS93系统检查肢体功能恢复情况。结果17例患者均获得随访,平均45个月（9～120个月）。3例患者术后6～14个月局部复发（占17．6％）。ⅡB期12例患者中,4例死于肺转移（占33％）;8例无瘤存活,存活时间50—120个月,平均75个月。ⅢB期5例,死亡5例,存活9—20个月,平均13个月。15例术后恢复行走,占88％,肢体功能恢复率40％～93％,平均74％。3例术后并发神经麻痹,2例术后髋关节脱位,无一例术后感染。结论全股骨人工关节置换术适用于股骨广泛受侵的恶性骨肿瘤患者,能有效恢复肢体功能;对于Ⅲ期患者,姑息性保肢治疗能有效地改善生活质量;人工全股骨关节的设计有待进一步改进。     

肱骨上段恶性肿瘤切除人工假体置换术

目的探讨应用人工假体置换治疗肱骨上段恶性肿瘤的手术疗效及并发症。方法1998年10月~2003年8月,收治肱骨上段恶性肿瘤4例。其中骨肉瘤2例,Enneking分期A期;骨巨细胞瘤2例,Enneking分期分别为A期和B期。根据国际保肢学会评分标准,术前综合评分骨肉瘤2例分别为4分和5分,骨巨细胞瘤2例分别是9分和11分。手术均采用距肿瘤边界以远5~8cm连同周围肌肉切除,行人工假体置换,骨水泥固定。结果4例均获随访24~58个月,平均44个月。术后无肿瘤复发及感染,1例于术后1年5个月出现假体松动,未作特殊处理。假体置换后肩关节伸22~41°(平均25°),屈29~80°(平均35°),外展5~28°,旋转15~22°。4例患者均有不同程度的肩关节不稳,力量减弱。根据国际保肢学会评分标准,术后综合评分骨肉瘤2例分别是19分和22分,较术前平均提高16分;骨巨细胞瘤2例分别是21分和28分,较术前平均提高9.5分。结论人工假体置换治疗肱骨上段恶性肿瘤,效果良好,但并发症较多,临床应用需慎重。     

骨干人工假体在股骨近端恶性肿瘤切除后骨缺损重建中的初步应用

 目的 探讨采用骨干人工假体对股骨近端骨干恶性肿瘤切除后结构性骨缺损进行重建的可行性。方法 2011年6月至2014年7月对7例股骨近端恶性骨肿瘤患者采用骨干人工假体置换,男3例,女4例;年龄28~76岁,平均61.8岁。原发恶性骨肿瘤4例,转移癌3例。术前常规行X线、CT及MR检查,通过MRI测量瘤段骨长度及软组织侵犯范围,再根据截骨长度选择骨干人工假体配件。取股骨近端外侧直切口,逐层切开皮肤、皮下组织,按肿瘤切除原则充分显露术前MRI测量的瘤段骨及软组织肿瘤并截骨,扩髓后安装骨干人工假体,依次缝合各层组织。术后切除组织送病理学检查。结果 手术时间45~120 min,平均90 min;术中出血量200~800 ml,平均400 ml。随访6~24个月,平均14个月。1例骨肉瘤患者术后1年因出现肺转移而死亡,3例原发恶性骨肿瘤患者术后未出现术区复发及远处转移。1例乳腺转移癌患者术前多发转移,术后行综合治疗,带瘤生存;2例乳腺转移癌患者随访期间未出现原位复发或转移。7例患者术后患肢髋关节功能均无受限。结论 使用骨干人工假体对股骨近端骨干恶性肿瘤切除后结构性骨缺损进行重建,保留了邻近的髋关节及肌腱附着点,操作简单,住院时间较短,可早期负重,是一种理想的治疗股骨近端骨肿瘤的保肢手术方法。     

腓肠肌瓣在膝关节周围恶性肿瘤保肢术中的应用

目的探讨腓肠肌肌瓣在膝关节周围恶性肿瘤保肢术中的临床疗效。方法 42例恶性骨肿瘤患者,其中男23例,女19例;年龄16～63岁,平均27岁。位于股骨远端26例,胫骨近段16例。骨肉瘤15例,滑膜肉瘤5例,软骨肉瘤4例,恶性骨巨细胞瘤13例,纤维肉瘤3例,恶性纤维组织细胞瘤2例。采用人工特制假体修复肿瘤切除后骨缺损的同时,制备带血管蒂的腓肠肌内侧头或外侧头肌瓣覆盖胫骨或股骨假体行软组织修复和功能重建。结果本组42例病例术后均获随访且均存活,随访时间5～38个月（平均24.6个月）。按Ennek ing等[1]肢体肌肉骨骼肿瘤外科治疗重建术后功能的评估标准进行评估,本组优25例（占59.5%）,良9例（占21.4%）,中6例（占14.3%）,差2例（占4.8%）,优良率80.9%。结论膝关节周围恶性骨肿瘤切除的保肢手术中,采用腓肠肌肌瓣移位可修复软组织缺损,降低局部并发症,提高临床治疗效果。     

肿瘤型假体置换术后再手术的原因与策略

目的探讨分析肿瘤型假体置换术后再手术的原因和策略。方法回顾1994年1月～2004年12月完成的85例肿瘤型假体置换术，其中21例因各种原因再次手术。男13例，女8例。再手术时年龄18～58岁。分别为骨肉瘤10例，软骨肉瘤4例，骨巨细胞瘤5例，骨纤维肉瘤2例，均由病理组织学证实。股骨远端9例，胫骨近端8例，股骨近端2例，肱骨近端及髋臼处各1例。Enneking分期IB期5例，ⅡB期16例。再手术距首次手术时间2周～20年。再手术的原因：肿瘤复发8例，假体松动5例，切口不愈合4例，关节脱位3例，假体断裂1例。行截肢术和肿瘤假体翻修术各6例，肿瘤扩大切除术3例，病灶清除腓肠肌内侧头肌瓣移位术4例，切开复位术和关节旷置术各1例。结果18例获随访1～5年，平均3年4个月。其中4例骨肉瘤患者因肺转移而死亡，余14例均无瘤生存，假体无松动，切口愈合良好。关节功能在可评价的13例患者中，参照保肢术后肢体功能评价标准，优2例，良5例，可4例，差2例。再手术后保留肢体功能满意率为84．6％，优良率为53．8％。结论肿瘤复发是肿瘤假体置换术后再手术的最常见原因，假体松动是导致肿瘤假体翻修术的另一主要因素；再手术时应根据不同原因行相应的治疗策略，在不违反保肢手术原则下，仍可行保留肢体的手术，并可获得满意的治疗效果。     

Does the Addition of a Vascularized Fibula Improve the Results of a Massive Bone Allograft Alone for Intercalary Femur Reconstruction of Malignant Bone Tumors in Children?

BackgroundMassive bone allograft with or without a vascularized fibula is a potentially useful approach for femoral intercalary reconstruction after resection of bone sarcomas in children. However, inadequate data exist regarding whether it is preferable to use a massive bone allograft alone or a massive bone allograft combined with a vascularized free fibula for intercalary reconstructions of the femur after intercalary femur resections in children. Because the addition of a vascularized fibula adds to the time and complexity of the procedure, understanding more about whether it reduces complications and improves the function of patients who undergo these resections and reconstructions would be valuable for patients and treating physicians.Questions/purposesIn an analysis of children with bone sarcomas of the femur who underwent an intercalary resection and reconstruction with massive bone allograft with or without a vascularized free fibula, we asked: (1) What was the difference in the surgical time of these two different surgical techniques? (2) What are the complications and number of reoperations associated with each procedure? (3) What were the Musculoskeletal Tumor Society scores after these reconstructions? (4) What was the survival rate of these two different reconstructions?MethodsBetween 1994 and 2016, we treated 285 patients younger than 16 years with a diagnosis of osteosarcoma or Ewing sarcoma of the femur. In all, 179 underwent resection and reconstruction of the distal femur and 36 patients underwent resection and reconstruction of the proximal femur. Additionally, in 70 patients with diaphyseal tumors, we performed total femur reconstruction in four patients, amputation in five, and a rotationplasty in one. The remaining 60 patients with diaphyseal tumors underwent intercalary resection and reconstruction with massive bone allograft with or without vascularized free fibula. The decision to use a massive bone allograft with or without a vascularized free fibula was probably influenced by tumor size, with the indication to use the vascularized free fibula in longer reconstructions. Twenty-seven patients underwent a femur reconstruction with massive bone allograft and vascularized free fibula, and 33 patients received massive bone allograft alone. In the group with massive bone allograft and vascularized fibula, two patients were excluded because they did not have the minimum data for the analysis. In the group with massive bone allograft alone, 12 patients were excluded: one patient was lost to follow-up before 2 years, five patients died before 2 years of follow-up, and six patients did not have the minimum data for the analysis. We analyzed the remaining 46 children with sarcoma of the femur treated with intercalary resection and biological reconstruction. Twenty-five patients underwent femur reconstruction with a massive bone allograft and vascularized free fibula, and 21 patients had reconstruction with a massive bone allograft alone. In the group of children treated with massive bone allograft and vascularized free fibula, there were 17 boys and eight girls, with a mean ± SD age of 11 ± 3 years. The diagnosis was osteosarcoma in 14 patients and Ewing sarcoma in 11. The mean length of resection was 18 ± 5 cm. The mean follow-up was 117 ± 61 months. In the group of children treated with massive bone allograft alone, there were 13 boys and eight girls, with a mean ± SD age of 12 ± 2 years. The diagnosis was osteosarcoma in 17 patients and Ewing sarcoma in four. The mean length of resection was 15 ± 4 cm. The mean follow-up was 130 ± 56 months. Some patients finished clinical and radiological checks as the follow-up exceeded 10 years. In the group with massive bone allograft and vascularized free fibula, four patients had a follow-up of 10, 12, 13, and 18 years, respectively, while in the group with massive bone allograft alone, five patients had a follow-up of 10 years, one patient had a follow-up of 11 years, and another had 13 years of follow-up. In general, there were no important differences between the groups in terms of age (mean difference 0.88 [95% CI -0.6 to 2.3]; p = 0.26), gender (p = 0.66), diagnosis (p = 0.11), and follow up (mean difference 12.9 [95% CI-22.7 to 48.62]; p = 0.46). There was a difference between groups regarding the length of the resection, which was greater in patients treated with a massive bone allograft and vascularized free fibula (18 ± 5 cm) than in those treated with a massive bone allograft alone (15 ± 4 cm) (mean difference -3.09 [95% CI -5.7 to -0.4]; p = 0.02). Complications related to the procedure like infection, neurovascular compromise, and graft-related complication, such as fracture and nonunion of massive bone allograft or vascularized free fibula and implant breakage, were analyzed by chart review of these patients by an orthopaedic surgeon with experience in musculoskeletal oncology. Survival of the reconstructions that had no graft or implant replacement was the endpoint. The Kaplan-Meier test was performed for a survival analysis of the reconstruction. A p value less than 0.05 was considered significant.ResultsThe surgery was longer in patients treated with a massive bone allograft and vascularized free fibula than in patients treated with a massive bone allograft alone (10 ± 0.09 and 4 ± 0.77 hours, respectively; mean difference -6.8 [95% CI -7.1 to -6.4]; p = 0.001). Twelve of 25 patients treated with massive bone allograft and vascularized free fibula had one or more complication: allograft fracture (seven), nonunion (four), and infection (four). Twelve of 21 patients treated with massive bone allograft alone had the following complications: allograft fracture (five), nonunion (six), and infection (one). The mean functional results were 26 ± 4 in patients with a massive bone allograft and vascularized free fibula and 27 ± 2 in patients with a massive bone allograft alone (mean difference 0.75 [95% CI -10.6 to 2.57]; p = 0.39). With the numbers we had, we could not detect a difference in survival of the reconstruction between patients with a massive bone allograft and free vascularized fibula and those with a massive bone allograft alone (84% [95% CI 75% to 93%] and 87% [95% CI 80% to 94%], respectively; p = 0.89).ConclusionWe found no difference in the survival of reconstructions between patients treated with a massive bone allograft and vascularized free fibula and patients who underwent reconstruction with a massive bone allograft alone. Based on this experience, our belief is that we should reconstruct these femoral intercalary defects with an allograft alone and use a vascularized fibula to salvage the allograft only if a fracture or nonunion occurs. This approach would have resulted in about half of the patients we treated not undergoing the more invasive, difficult, and risky vascularized procedure.Level of Evidence Level III, therapeutic study.     

肿瘤型假体重建膝关节周围原发性肿瘤切除后骨缺损

目的总结膝关节周围原发性骨肿瘤保肢手术中人工关节重建的疗效和并发症。方法回顾性分析我院1995年12月至2005年12月83例应用肿瘤型假体重建膝关节周围骨肿瘤切除后骨缺损的临床资料。其中骨肉瘤58例,多中心骨肉瘤2例,皮质旁骨肉瘤1例,恶性纤维组织细胞瘤4例,骨巨细胞瘤13例,平滑肌肉瘤1例,尤文肉瘤2例,软骨肉瘤2例。根据骨缺损重建部位分组：股骨下端组44例,胫骨上端组34例,全股骨置换组5例。结果所有患者均获得随访,随访时间12～130个月,平均41个月。局部复发6例,2例晚期感染,假体松动2例,无假体断裂;假体3、5年生存率分别为88．2％、82．1％。41例植骨患者形成皮质外骨桥。肢体肌肉骨骼肿瘤外科治疗重建术后功能评分：股骨下端组19．0—29．0分,平均25．0分;胫骨上端组17．0—28．0分,平均24．4分;全股骨置换组16．0—21．0分,平均19．0分。股骨下端组和胫骨上端组功能优于全股骨置换。结论肿瘤型人工关节重建膝关节周围骨肿瘤并发症发生率低,关节功能良好。     

Open supracondylar femur fractures with bone loss in the polytraumatized patient – Timing is everything!

Introduction

Open supracondylar femur fractures are rare, complex injuries which occur in polytrauma patients and are complicated by bone loss, contamination, compromised soft tissues, and poor host condition. The purpose of this study is to demonstrate a successful treatment protocol for these challenging injuries.

Methods

A consecutive series of 15 open supracondylar femur fractures in 14 polytrauma patients (ages 16–75, mean 41) were treated at one Level I trauma centre by a single surgeon. Fracture patterns included seven AO/OTA Type C2 and eight Type C3 fractures. All fractures were open and classified by Gustillo/Anderson as type IIIA (10 fractures) and type IIIB (five fractures). Stage I was performed within 24 h and included thorough open fracture care and early definitive fixation with a laterally based locking device and antibiotic bead placement. Stage II was performed several months later (average 3.6 months) when the soft tissue envelope had revascularized and the polytrauma patient had recovered from their other injuries. Stage II consisted of either an anterior incision or subvastus approach to the distal femur, bone grafting, BMP application, and addition of medial column support to create rigid fixation.

Results

All fractures (15/15) healed uneventfully. Union was determined by absence of pain and radiographic union in 3/4 cortices. Mean time to union was 4 months. There were no deep infections and alignment was maintained (average tibiofemoral angel of 5° of valgus) although several limbs were complicated by knee stiffness.

Conclusions

Healing of open supracondylar femur fractures with critical sized bone defects requires diligent surgical timing in order to optimise the host and wound bed. Thorough initial debridement and early definitive fixation halt ongoing soft tissue injury, restores length and alignment, and allow for sterilisation of the wound. After patients have recovered from their other injuries and the soft tissue sleeve has revascularized, bone grafting with BMP supplementation and medial column plating allows for rigid fixation of the femur and offers the biology these fracture patterns require for successful union without infection.     

Endoprosthetic reconstruction for large extremity soft-tissue sarcoma with juxta-articular bone involvement: functional and survival outcome

Background

Large extracompartmental limb soft-tissue sarcoma with juxta-articular bone involvement poses major challenges in disease management. Radical resection of sarcoma frequently requires concomitant bone resection and reconstruction. We describe the clinical outcomes of endoprosthetic reconstruction and the complications associated with this procedure.

Methods

Thirty patients with soft-tissue sarcomas with local juxta-articular bone involvement in an extremity underwent surgery at our center between May 2004 and October 2011, 20 for primary sarcomas and 10 for local recurrences. Clinical data from those patients were analyzed retrospectively. The bone affected included the proximal femur (10 cases), the distal femur (nine cases), the proximal humerus (eight cases), the proximal tibia (two cases), or the total femur (one case). Wide excision of the tumor and the bone tissue involved was performed on every patient, followed by reconstruction of the subsequent defect using tumor endoprosthesis. All patients underwent regular follow-up for an average of 25 (range, 3–84) mo.

Results

Three patients had poor wound healing. Implant fractures leading to additional revisions occurred in two cases. Local tumor recurrence developed in four patients. There were 15 patients with lung metastases, and 11 patients died of disseminated metastases. In the latest follow-up, 14 patients survived free of disease and five were alive with tumors. The mean Musculoskeletal Tumor Society functional analysis for proximal femur, distal femur, proximal tibia, proximal humerus, and total femur were 90%, 82%, 73%, 71%, and 60%, respectively. The 2- and 5- y survival rates were 61.6% and 30.0%, respectively.

Conclusions

Endoprosthetic reconstruction could yield satisfactory results as a wide excision and limb salvage therapeutic strategy for patients with large extracompartmental soft-tissue sarcomas with juxta-articular bone involvement. Acceptable complications occurred in the present report.     

骨膜骨肉瘤与高度恶性表面骨肉瘤

目的报告表面骨肉瘤的两种少见亚型,即骨膜骨肉瘤和高度恶性表面骨肉瘤的诊治经验。方法回顾 5例骨膜骨肉瘤和 4例高度恶性表面骨肉瘤患者的影像学和病理学特点,并对临床治疗结果进行分析。 5例骨膜骨肉瘤患者,男 1例,女 4例;年龄 28～ 42岁,平均 35岁;肿瘤位于胫骨上段者 4例,股骨下段者 1例。 4例高度恶性表面骨肉瘤患者,男 3例,女 1例;年龄 17～ 23岁,平均 19.25岁; 4例患者肿瘤均位于股骨下段。结果 5例骨膜骨肉瘤均予以广泛切除,除 1例因局部复发行截肢术,现无瘤生存 1年 3个月外,余 4例已无瘤生存 3～ 9年,平均 5年 9个月。 4例高度恶性表面骨肉瘤患者,虽经积极综合治疗,但仅 1例无瘤生存 7年; 1例术后 2年 5个月复发而截肢,现无瘤生存 1年 9个月; 1例于术后 2年 4个月死于肺转移;另 1例在确诊后 3个月死亡。结论骨膜骨肉瘤和高度恶性表面骨肉瘤各具鲜明的影像学和病理学特点,骨膜骨肉瘤恶性程度较低,应采用以局部广泛切除为主的手术治疗,预后相对较好;而高度恶性表面骨肉瘤的生物学行为则与经典的髓内骨肉瘤相似,预后较差,必须采用手术与化疗相结合的综合治疗方法。