保肢手术治疗骨肉瘤的回顾性对照研究

目的:评价不同术式联合化疗治疗骨肉瘤的临床效果。方法:回顾性分析1995~2003年手术治疗的43例骨肉瘤患者的临床资料,其中24例(截肢组)患者行截肢术,19例(保肢组)行保肢手术(18例灭活再植,1例人工假体置换)。术前介入化疗 放疗、化疗26例,术后单纯化疗17例,37例患者获术后随访时间3~6年。结果:保肢组发生术后并发症7例(37%),其中骨折4例,感染2例,延迟愈合1例;按Enneking评定标准,优良率为74%(14/19);3年无瘤生存率、局部复发率、肺部转移率:保肢组分别为42.1、21.1%、42.1%,截肢组分别为38.9%、11.1%、50.0%,两组间比较无显著性差异(P<0.05)。结论:在手术联合化疗的模式下,保肢术和截肢术可获得类似的疗效,且保肢术可以保留病变部位原有形态及部分功能,但要注意预防术后并发症。

Limb-Sparing Surgical Operation in Treatment of Osteosarcoma:a Retrospective and Control Study

Objective:To evaluate the outcome of different surgical operation options combined with chemotherapy for osteosarcoma.Methods:A retrospective analysis was conducted on clinical data from 43 patients with osteosarcoma undergoing surgical operations from 1995 to 2003.Among them,24 underwent amputation and 19 receive limb-sparing surgery(18 patients received devitalized tumor bone reimplantation,one patient prosthetic replacement).Preoperative interventional chemotherapy and postoperative chemotherapy radiotherapy were performed in 26 patients and postoperative adjuvant chemotherapy in 17 patients;37 patients were followed up for 3 to 6 years.Results:Of the 19 patients undergoing limb-sparing surgery,7 had postoperative complications(37%);4 of these 7 cases had frcture;2 had infection,1 patients had delayed union.Functional test showed excellent or good results in 14 out of 19 patients according to Enneking Scoring system.In limb-sparing surgery group,the proportion of patients with 3-year disease-free survival(DFS) was 42.1%;local recurrence rate was 21.1%,and lung metastasis rate was 42.1%.In amputation patients,the above parameters were 38.9%,11.1%,and 50.0%,respectively.There was no significant difference between the two groups.Conclusion:In the combined treatment program,amputation and limb-sparing surgery would lead to a similar clinical outcome.Limb-sparing surgery could retain the function of lesion sites.Nevertherless,attention should be payed to prevent its complications.