手术治疗四肢长骨转移性骨肿瘤32例临床分析

目的 探讨四肢转移性瘤手术治疗的方法与疗效.方法 2000年6月至2007年6月明确诊断的96例四肢骨转移性肿瘤患者中,32例接受外科手术治疗,其中人工关节置换14例,异体骨加带锁髓内钉内固定10例,骨水泥加带锁髓内钉内固定5例,骨水泥加钢板内固定2例,异体骨加钢板内固定1例.结果 术中顺利,术后无感染.32例患者随访3-60个月,平均36个月.1例股骨中段异体骨植骨加髓内钉内固定于术后3个月出现内固定松动,12例异体骨移植患者中,3例在随访结束时移植骨与宿主骨未达到骨性愈合,但不影响功能.所有患者术后疼痛得到明显缓解,Enneking评分：功能为优78.2%,中16.8%,差5.0%.患者2年生存率为34.6%,5年生存率为16.7%.结论 手术治疗四肢转移性肿瘤可以有效缓解疼痛、预防病理性骨折的发生、改善肢体功能及提高患者的生存质量.

Surgical treatment for metastatic tumor in long bones of the limbs

Objective To study the method and therapeutic effect of the surgical treatment for metastastic tumor in long bones of the limbs. Methods Between June 2000 and June 2007, 96 patients with metastatic tumor in long bones of the limbs were treated in our hospital. 32 underwent surgeries, including artificial joint replacement （n=14）, bone allografi with interlocking intramedullary nailing （n=10）, bone cementing and interlocking intramedullary nailing （n=5）, bone cementing and internal fixation with steel plate （n=2）, and bone allograft with internal fixation with steel plate （n=1）. Results No infection was reported after surgery. All patients were followed up for 3 to 60 months, with average being 36 months. Of the patients who underwent bone allografi with interlocking intramedullary nailing, i sustained fixation loosening in 3 months after surgery in the central segment of femur. Among the 12 patients who underwent bone allograft, 3 did not achieve bone union of the bone graft and the host bone, while the bone function was not affected. Pain was relieved in all patients after surgery. The Enneking scores showed excellent function （78.2%）, fair （16.8）, and poor （5.0%）. The 2-year survival rate was 34.6%. The 5-year survival rate was 16.7%. Conclusions Surgical treatment for patients metastastic tumor in long bones of the limbs can relieve tile pain effectively, prevent pathological fracture occurrence, and improve the limb function and life quality.