切除瘤段骨体外辐照与乙醇灭活再植术在恶性骨肿瘤保肢术中应用效果的对比研究

目的 探讨瘤段骨术中体外辐照灭活与乙醇灭活再植术在恶性骨肿瘤保肢治疗中的应用效果,以助临床选择更加安全有效的瘤段骨灭活方法。方法 回顾性队列研究,纳入2008年1月—2016年1月郑州大学附属肿瘤医院收治的54例恶性骨肿瘤患者,其中男27例、女27例,年龄7~58(20.58±12.89)岁。54例患者均未出现肿瘤转移,均接受瘤段骨灭活再植术治疗;根据瘤段骨灭活再植方式分为辐照组25例,乙醇组29例。比较两组患者肿瘤复发率、骨愈合率、灭活骨愈合时间,以及骨不连、骨折或内固定断裂、感染、骨吸收等并发症的发生率。结果 54例患者术后均获得随访。辐照组25例随访时间(20.48±6.39)个月,复发1例(4%),骨愈合16例(64.00%),灭活骨愈合时间(8.75±2.38)个月,感染2例(8%);乙醇组29例随访时间(41.79±24.74)个月,复发5例(17.24%),骨愈合13例(44.83%),灭活骨愈合时间(25.31±13.62)个月,感染2例(6.4%)。两组患者灭活骨愈合时间对比差异有统计学意义(P ＜0.01);组间复发率、骨愈合率、骨不连率、钢板断裂率,以及灭活骨骨折率、感染率、骨吸收率对比,差异均无统计学意义(P值均＞0.05)。结论 切除瘤段骨术中离体辐照灭活再植术与乙醇灭活再植术均有较好的临床效果。辐照灭活法在安全性、灭活骨愈合速度方面显著优于乙醇灭活法;但辐照灭活需要专业设备,限制了其应用。

Comparative study or the effect of extracorporeal irradiation of tumor segment and alcohol inactivation during limb salvage surgery for malignant bone tumors

Objective To compare and analyze the effects of intraoperative extracorporeal irradiation (IEI) and alcohol inactivation (AI) in the surgery of limb salvage in malignant bone tumors, and to provide references for clinical selection of safer and more effective methods of tumor segment bone inactivation.Methods The clinical data of 54 patients with malignant bone tumors who received IEI or AI bone replantation in the surgery of malignant bone tumors at the Affiliated Cancer Hospital of Zhengzhou University from January 2008 to January 2016 without tumor metastasis were retrospectively analyzed. Among the 54 patients, there were 27 males and 27 females, aged 7-58 (20.58±12.89) years. According to the method of bone inactivation and replantation, the patients were divided into the irradiation group (25 patients) and the alcohol group (29 patients). The differences of tumor recurrence, bone healing rate, bone healing time, bone nonunion rate, fracture rate, infection rate and bone absorption rate were compared between the two groups.Results Twenty-five cases were treated with IEI, the average follow-up was 20.48±6.39 months. One patient had local recurrence (4%). Bone healing occurred in 16 patients (64.00%), with an average of (8.75±2.38) months of bone healing time. There were infections in 2 patients (8%). The mean follow-up time of 29 patients receiving AI replantation was (41.79±24.74) months, 5 patients (17.24%) relapsed, 13 patients (44.83%) healed, the mean bone healing time was (25.31±13.62) months, and 2 patients (6.4%) were infected. The healing time of inactivated bone was significantly different between the two groups (P＜0.01), and the tumor recurrence, bone healing rate, bone nonunion rate, fracture rate, infection rate and bone absorption rate were not significantly different between the two groups(all P values＞0.05).Conclusions Both methods were effective. Irradiation inactivation method is superior to alcohol inactivation method in safety and the mean healing time of inactivated bone. However, irradiation inactivation requires professional equipment and limits its application.