摘要
目的探讨腓骨近端侵袭性及恶性原发性骨肿瘤的手术治疗方式、治疗效果及术后并发症处理。方法回顾分析2006年1月至2017年12月,本院收治腓骨近端侵袭性及恶性原发性骨肿瘤28例,其中男18例、女10例,年龄9~68岁,中位年龄19岁。其中骨肉瘤19例,骨巨细胞瘤5例,纤维肉瘤1例,平滑肌肉瘤1例,原始神经外胚层肿瘤2例。19例骨肉瘤患者,3例行截肢术,14例行Malawer I型切除,2例行Malawer II型切除。5例骨巨细胞瘤患者,1例行Malawer III型切除,余4例行I型切除。1例纤维肉瘤与1例平滑肌肉瘤行I型切除。2例原始神经外胚层肿瘤患者,1例因瘤体侵犯范围大行截肢术,1例行I型切除。对于保肢手术患者采用MSTS评分系统评估膝关节功能。结果28例随访7~120个月。19例骨肉瘤患者中,3例接受截肢手术者均死亡。14例Malawer I型保肢手术者,6例发生复发和(或)肺部转移,8例末次随访时无瘤生存。发生复发及肺部转移的6例患者中,2例死亡,4例随访期内带瘤生存。2例Malawer II型手术患者无瘤生存。5例骨巨细胞瘤患者、2例原始神经外胚层肿瘤患者、2例软组织肉瘤患者术后均无复发或转移。24例保肢者中,6例术后出现腓总神经麻痹,2例自行恢复,1例轻度跛行,3例因腓神经切除出现足下垂须佩戴支具。16例骨肉瘤保肢手术患者MSTS评分为(22.07±1.75)分,5例骨巨细胞瘤患者术后MSTS评分为(26.33±0.96)分,2例原始神经外胚层肿瘤患者及2例软组织肉瘤患者MSTS评分为28分。结论选择腓骨近端肿瘤手术方式应充分评估患者病情,边缘性切除适合对于腓骨近端侵袭性肿瘤或对于术前化疗敏感的骨肉瘤患者。扩大切除适合对于瘤体较大,恶性程度高或对化疗不敏感的恶性肿瘤。对于腓骨近端肿瘤切除后,外侧副韧带及股二头肌腱简单重建即可获得良好的膝关节稳定效果。
Objective To explore the surgical design,postoperative complications and management strategies of aggressive and malignant primary bone tumors in the proximal fibula.Methods Twenty-eight patients(18 males;10 females)with aggressive and malignant primary bone tumors in the proximal fibula were admitted in our center between January 2006 and December 2017.All were retrospective analyzed,including 19 osteosarcoma,5 bone giant cell tumors,1 fibrosarcoma,1 leiomyosarcoma and 2 primitive neuroectodermal tumors.The mean age was19 years(range:9-68 years).Among 19 patients with osteosarcoma:3 underwent amputation;14 underwent Malawer I resection;2 underwent Malawer II resection.Among 5 patients with bone giant cell tumors:1 underwent Malawer III resection;4 underwent Malawer I resection.One patient with fibrosarcoma and 1 patient with leiomyosarcoma underwent Malawer I resection.Among 2 patients of primitive neuroectodermal tumors:1 underwent amputation due to the massive invasion of the tumor;1 underwent Malawer I resection.Knee functions following limb salvage were evaluated by the Musculoskeletal Tumor Society(MSTS)scoring system.Results All patients were followed up for 7-120 months.Three osteosarcoma patients after amputation died.Among 14 patients after Malawer I limb salvage surgery:6 patients had recurrence and/or pulmonary metastasis(2 died,4 survived with tumors during follow-up);8 patients survived without tumor at the latest follow-up.Two patients survived after Malawer II limb salvage surgery without tumors.There was no recurrence or metastasis in 5 patients with bone giant cell tumors,2 patients with primitive neuroectodermal tumors and 2 patients with soft tissue sarcoma.Of the 24 patients after limb salvage surgery:6 had common peroneal nerve palsy(2 recovered spontaneously);1 had mild claudication;3 had foot drop due to fibular nerve resection.MSTS scores:(22.07±1.75)of 16 patients with osteosarcoma;(26.33±0.96)of 5 patients with bone giant cell tumors;28 of 2 patients with primitive neuroectodermal tum
作者
何志伟
樊根涛
张军良
朱岩
曹莉莉
周幸
周光新
HE Zhi-wei;FAN Gen-tao;ZHANG Jun-liang;ZHU Yan;CAO Li-li;ZHOU Xing;ZHOU Guang-xin(Department of Orthopaepdics,Eastern Theater General Hospital of PLA,Nanjing,Jiangsu,210002,China)
出处
《中国骨与关节杂志》
CAS
2020年第5期336-340,共5页
Chinese Journal of Bone and Joint
基金
国家自然科学基金面上项目(81472508)
国家自然科学基金(81802693)
军队医学科技青年培育计划孵化项目(19QNPO38)
军队后勤科研项目(CLB18J032)。
关键词
骨肿瘤
手术
骨肉瘤
腓骨
Bone neoplasms
Surgery
Osteosarcoma
Fibula
