侵袭性骨肿瘤保肢关节功能重建手术方法探讨

为了探讨侵袭性骨肿瘤的保肢手术治疗方法及其临床疗效。我们保肢手术治疗四肢骨肿瘤31例,包括肱骨上段软骨肉瘤行保留主要血管神经的瘤段切除肢体缩短术（Tikhoff-Linbeng）、瘤段切除人工关节置换术以及瘤段切除同种异体半关节移植术。根据病灶的病理特性、部位和范围等条件,分别采用瘤段切除人工假体置换术和瘤段切除异体骨关节置换术等手术方法,联合全身化疗、介入化疗或术中肿瘤供血动脉灌注化疗。结果按Mankin评定标准,优7例,良12例,中7例,差5例,治疗满意率为83.87%。初步研究结果提示,恰当的手术方法、并行关节功能重建以及完整的化疗方案治疗四肢恶性骨肿瘤提高了患者的生存质量,减少了致残率,效果满意,并未降低患者的生存率。

Clinical investigation on curative methods of operation of limb-salvage and joint function restoration for malignant bone tumor

The objective of this study was to explore the operation methods and clinical curative effect of operation of reserving limbs for malignant bone tumor.Thirty-one cases of bone neoplasms underwent the operation of reserving limbs.Many kinds of operation methods were adopted according to the pathologic features of the region and ranges of the focus,and they included superior of humerus' chondrosarcoma row neoplasia segment resection limb shortening with keeping main vessel and neural(Tikhoff-Linbeng),tumor bone excision and artificial prosthesis replacement,tumor bone excision and heterogeneous osteoarticular replacement.In the meantime,systemic chemotherapy,interventional treatment and intraoperative arterial infusion were performed respectively.Results according to Mankin evaluation standard.excellent was in 7 cases,good 12 cases,fair 7 cases,bad 5 cases,and the rate of treatment satisfaction was 83.87%.Conclusion: Proper operative treatment of reserving limbs and reconstruction of joint function for malignant bone tumor with complete chemotherapy scheme could raise patient's survival quality and reduce maimed patients for operation type,gain better effect;but survival rate is not decreased.