高速磨钻在侵袭性骨肿瘤治疗中的应用

目的：探讨高速磨钻在治疗侵袭性骨肿瘤治疗中的作用。方法：首先开窗刮除瘤腔内肿瘤组织，然后直视下应用高速磨钻沿各个方向仔细磨除瘤腔内壁表面骨嵴，尤其是瘤腔顶部，额外磨除瘤腔皮质骨下1～5mm的骨组织，直至显露正常骨质。必要时也磨除部分软骨下骨，部分病变区域需至关节软骨平面。选择非结构性移植物，包括自体髂骨或同种异体骨、碳酸化羟基磷灰石，填充骨缺损。结果：术后平均随访时间27个月(7～41个月)。3例局部复发，无远处脏器转移。术后关节功能轻度受限1例；切口早期炎性反应2例；深部感染1例；病变部位远侧肿胀1例。未发生继发性病理骨折。结论：高速磨钻对骨组织具有较强的切割作用，能较易磨平凸出的骨嵴，虽然仍为病灶内手术，但应用高速磨钻后扩大了手术切除的范围，可以达到边缘切除的效果，保证手术的彻底性。

Aggressive bone tumors treated with curettage and a high-speed burr

Objective:To evaluate the effect of high speed burr in treatment of aggressive bone tumors Method: Sixty five patients with aggressive bong tumors,were managed with curettage combined with a high speed burr The operative technique of curettage required a large cortical window which provided straightforward visualization of the entire tumor cavity The intraosseous tumor bulk was removed with an intralesional technique with use of a large curet The cavity was then enlarged in all directions with a high speed burr under direct vision until the normal bone could been seen Result:According to the criteria of Enneking classification system,all of patients had a stage 3 lesion The mean duration of follow up time was 27 months There were 3 cases of local recurrence at the latest follow up examination,5 patients had postoperative complication,including inflammatory of the incision(2 cases),deep infection(1 case),stiffness of the wrist(1 case),swelling of the distal part of the lesion(1 case).There was no pathological fracture after operative Conclusion: High speed burr can enlarge the tumor cavitic wall,eliminate the microscopic remnants of the tumor from the cavity after curettage Equivalent results of marginal resection could be obtained with curettage combined with a high speed burr in the treatment of aggressive bone tumors