MRI在四肢长骨恶性骨肿瘤保肢手术中的应用

目的：研究MRI在肢体恶性骨肿瘤保肢手术中的应用价值。方法：176例肢体恶性骨肿瘤患者，按照术前是否行MRI检查分为二组，40例术前未行MRI检查的病人在保肢手术中行截骨端快速冰冻切片和石蜡切片来判断切除边界，136例术前行MRI检查的病人，根据MRI显示的范围确定术中肿瘤灭活的范围。结果：一组病例中临近肿瘤灭活骨处复发2例，二组中发现3例骨内跳跃性病变，术后无1例临近肿瘤灭活骨处复发。结论：MRI对于肢体恶性骨肿瘤髓腔内侵润范围及骨内跳跃性病变有较好的诊断作用，应作为恶性骨肿瘤保肢手术前的常规检查。

MRI IN THE LIMB-SAVING SURGERY OF MALIGNANT BONE TUMORS IN LONG BONE OF EXTREMITIES

Objective:To investigate the siginficance of MRI examination before limb- saving surgery of malignant bone tumors in long bone of extremities. Methods: 176 patients of malignant tumors was divided into two groups according to accept or not accept MRI before limb - saving surgery. In group one, we employed frozen section in the site of osteotomy to judge the margin in 40 patients who had not accepted MRI before limb - saving. In group two, we estimated the safe margin according MR in 136 patients who had accepted MRI before limb- saving. Results: In group one, 2 patients had local recurrence in site of part of osteotomy segment in one and half year. In group two, we diagnosis 3 patients with skip lesion by MRI and SPECT pre - operation, 2 in the same bone matrix with primary tumor; 1 in the talus, we devitalized both primary and skip lesion in the same time operation by microwave induced hyperthermia and have not seen any local recurrence in the site of bone in group two after 2~5 years follow up. Conclusions: MR I is great helpful to estimate the aggressive extent of tumor cells and skip lesion of bone. MRI plus SPECT should be applied conventionally in the patients with bone tumors before limb - saving surgery.