节段型骨干肿瘤假体置换治疗骨干恶性肿瘤

恶性骨肿瘤的治疗应是在化疗、放疗等辅助治疗基础上的瘤段根治性切除。恶性骨肿瘤瘤段切除后的保肢重建方法依肿瘤病灶部位的不同应有所区别，对位于干骺端的恶性骨肿瘤，可采用人工关节假体置换术、同种异体骨半关节移植术、关节融合术等；而对于发生在骨干部位的恶性肿瘤，手术方式的选择更广。随着新辅助化疗的日渐成熟、影像学的进步以及骨大段缺损重建技术的发展，保肢治疗得以迅速发展。大量实践证明，保肢治疗具有安全性，其与截肢治疗的生存率和复发率几乎相当［1］。

Segmental intercalary diaphyseal endoprosthetic replacement for malignant diaphyseal bone tumors

Radical excision of tumor segments should be used in the treatment of malignant bone tumors accompanied by the adjuvant therapies including chemotherapy, radiotherapy and so on. The reconstruction methods of limb salvage after the excision of malignant tumor segments is chosen based on the tumor site. For the malignant bone tumors in the metaphysis, reconstructive surgeries such as artificial endoprosthetic replacement, osteoarticular allograft transplantation, arthrodesis and so on can be applied after the oncologic resection. More reconstruction methods may be chosen when the diaphyseal malignant bone tumors are resected. Surgical margin is an important factor, which affects the prognosis of patients. Different grades of bone tumors determine different choices of the surgical margin. The surgical margin of wide excision is required in the surgeries for patients with malignant bone tumors. The previous surgical procedures for the long-tubular diaphyseal bone tumors include amputation, bone-joint resection, integrated bone resection and so on, with the disadvantages of severe surgical trauma, slow recovery and poor limb function postoperatively. With the gradual maturity of the neoadjuvant chemotherapy, the advance of the radiology and the development of the reconstruction technology for massive bone defects, the limb salvage treatment is proved to be developed rapidly. A great number of practices have proved that the limb salvage treatment is safe, and there is almost no difference in the survival rate and recurrence rate, when compared with that of the amputation. The functional reconstruction surgery after the excision of the long-tubular diaphyseal bone tumors is generally recognized and promoted because it retains good limb function in patients. Surgical options mainly include transplantationof massive bone allografts, autogenous bone graft, segmental intercalary endoprosthetic replacement and so on. Every surgical procedure mentioned above has its specific advantages and disadvantages, and the indications of these procedures are different. The state of the patients with tumors is also different from each other. In order to promote the survival rate and the quality of life to the largest degree in patients, it is better to choose an appropriate individualized operative approach. With the rapid development of biomaterial, biomechanics, radiology, internal fixation technique and so on in recent years, segmental intercalary diaphyseal endoprosthesis has been widely applied and developed in the wide excision and reconstruction of diaphyseal bone tumors. In this article, the respective advantages and disadvantages of the previous reconstruction methods of limb salvage after the resection of the long-tubular diaphyseal bone tumorswere briefly reviewed, and the superiority and application of segmental intercalary diaphyseal endoprosthetic reconstruction were focused on.