新辅助化疗加保肢治疗四肢成骨肉瘤

目的 对成骨肉瘤患者实施新辅助化疗加保肢治疗后进行随访分析.方法 121例经病理诊断为成骨肉瘤患者,根据Enneking分级实施新辅助化疗,化疗药物为氨甲喋磷、顺铂、阿霉素和异环磷酰胺,部分ⅡB期的患者术前实施肿瘤血管栓塞.术后根据肿瘤坏死率选择化疗药物进行进一步化疗.手术方法主要为大段同种骨与关节移植47例,人工肿瘤型假体置换52例.随访采用MSTS保肢评分系统对保肢者进行功能评分.结果 121例患者随访16～101个月,生存76例,总生存率62.8% .大段同种移植骨与关节移植47例,术后3～24个月完成骨愈合,MSTS得分(22.60±4.13)分,优良率76.3% .肿瘤型假体置换52例患者,MSTS得分(24.32±3.85)分,优良率84.6% .结论 新辅助化疗加保肢手术是目前临床治疗成骨肉瘤较为有效的方法.

Treatment of extremity osteosarcoma with neoadjuvant chemotherapy and limb salvage

Objective To analyze the outcomes of treatment of extremity osteosarcoma after neoadjuvant chemotherapy and limb salvage operation.Methods On the basis of Enneking grading,preoperative chemotherapy with methotrexate, cisplatin, doxorubicin, and ifosfamide was given in 121 patients of extremity osteosareoma, some of whom with liB tumors received extra interventional embolism followed by postoperative chemotherapy according to the tumor necrosis rate.Most of the patients underwent limb salvage operation(99/121), and the Musculoskeletal Tumor Society(MSTS) score was used to evaluate the recovery of the limb function.Results The follow up lasted for 16-101 months with a survival rate of 62.8%(76/121).In 47 cases underwent osteoarticular allografts, the mean MSTS score was 22.60±4.13,and the overall excellent and good function outcome was obtained in 76.3% of the patients.Fifty patients underwent custom-made or modu[ar tumor endoprosthesis replacememt bad MSTS of 24.32 ± 3.85 with an overall excellent rate of 84.6%.Conclusion Neoadjuvant chemotherapy and limb salvage surgery are effective in treating osteosarcoma.