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：2000年4月～2001年9月收治长骨侵袭性骨肿瘤病例28例，采用高速磨钻方法治疗17例。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，直到显露正常骨质。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。即使病变部位骨皮质因侵蚀破坏后变薄或已经穿破，应用高速磨钻可能钻破骨皮质，也应继续磨除残留骨皮质，达到磨除干净为止。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16个月(7～24个月)。无局部复发及远处脏器转移。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：侵袭性骨肿瘤腔壁在肉眼和显微镜下均可见凸凹不平的骨嵴，常刮匙并不能刮除骨嵴间的肿瘤细胞。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。高速磨钻的应用是减少侵袭性骨肿瘤复发的有效手段，值得普及、推广。

Treatment of aggressive bone tumors of long bones with curettage with a high-speed burr

Objective:A variety of treatments have been advocated for aggressive bong tumors of long bones,including en bloc resection,curettage with adjuvant therapy,such as application of phenol,bone cement,or liquid nitrogen after curettage.But the high risk of recurrence after curettage is still a big problem in clinic syudy of the aggressive bone tumors.The rates of local recurrence after curettage have varied widely.We treat the aggressive bone tumors with curettage and high-speed burr to try to decrease the risk of recurrence.Methods:Seventeen patients who had an aggressive bong tumors,including giant-ceel tumor(11 cases),aneurysmal bone cyst(2 cases),giant-cell tumor accompained with aneurysal bone cyst(3 cases),chondroblastoma(1 case),were managed with curettage combined with use of a high-speed burr at our department from Apr 2000 and Sep 2001.The operative technique of curettage required a large cortical window that 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 ben seen.Results:According to the criteria of Enneking classifying system,all of patients had a stage-3 lesion.The mean duration of follow-up time was 16 months.There was no local recurrence at the latest follow-up examination.5 patients had a 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 wass,eliminate the microwscopic emnants of the tumor from the cavity after curettage.Equivalent results of marginal resection could be obtained with curettage combined with a high-speed of marginal resection could be obtained with curettage combined with a high-speed burr in the aggressive bone tumors.