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四肢骨骼系统恶性肿瘤保肢治疗的组织修复
及功能重建
作者：张培良，辛杰，李恩惠，孙学成
【摘要】 ［目的］探讨恶性骨肿瘤切除后，采用同种异体骨移植和自体瘤段骨灭活再植进行保肢治疗的过程中组织修复及功能重建的重要性。［方法］回顾性研究本院收治的56例恶性骨肿瘤患者，其中男35例，女21例；年龄9～60岁，平均19岁。位于肱骨近段者9例，股骨远端30 例，胫骨近段17例。成骨肉瘤32例，软骨肉瘤17例，恶性骨巨细胞瘤3例，转移瘤4例。采用同种异体骨移植和自体瘤段骨灭活再植修复肿瘤切除后骨缺损的同时行软组织修复和功能重建，按Mankin分级法评价保肢术后功能恢复情况，骨愈合情况及并发症等。［结果］本组优20例占35.7%，良11 例占19.6%，可8例占14.3%，差17例占30%，治疗满意率70%。56例中无瘤存活38 例，死亡12 例，5年生存30 例，生存率55%。其中51例随访时间超过10个月，均骨性愈合，无骨不连。除局部肿瘤复发以外，常见并发症有感染4例，骨折3例，关节面塌陷1例，关节强直5例，感染率仅7%。无内固定折断。［结论］采用同种异体骨移植和自体瘤段骨灭活再植对四肢恶性骨肿瘤行有效的组织修复和功能重建，不但可以保留肢体，且保留的肢体具有良好的功能，为四肢骨骼系统恶性肿瘤患者开辟了有效的治疗途径。
【关键词】 四肢恶性肿瘤; 保肢治疗; 组织修复; 功能重建 Abstract: ［Objective］To discuss the significance of
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tissue repairing and functional reconstruction in treatment of extremity malignant tumors by allogeneic bone graft and replanting devitalized bone after malignant bone tumor resection. ［Method］A retrospective study of 56 patients with malignant bone tumor was conducted, including 35 male patients and 21 female patients. The age was between 9 and 60, with an average of 18.Tumor in 9 cases was in the proximal hunerus, 30 in the distal femur, and 17 in the proximal cnemis.Thirty-two cases were osteogenic sarcoma,17 cases were chondroma sarcomatosum,3 cases were maligant giant cell tumor of bone and 4 cases were metastatic.Soft tissue was repaired and extremity function was reconstructed by adopting allogeneic bone graft and replanting devitalized bone. Extremity functions, bone healing conditions, and complication were estimated according to Mankin metheds.［Result］Among these 56 patients,results in 20(35.7%) were excellent,11(19.6%) were good,8(14.3%) were fair,17 (30%) were poor. The satisfactory rate was 70%.Thirty-eight patients survived for two years without tumor.Thirty patients survived for 5 years with the survival rate of 55%. Except local relapsed, the major complications were infection (4 cases), fracture (3 cases),collapse of articular facet (1 cases), and arthrocleisis (5 cases),with the infection rate of 7%.No internal fixation was
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broken.［Conclusion］For extremity malignant tumor, effective tissue repairing and functional reconstruction not only offer a limb-sparing effect, but also keep the limb in good function. This is an effective method for bone malignant tumor.
Key words：extremity malignant; limb salvage treatment; tumor tissue repairing; functional reconstruction
四肢恶性骨肿瘤是威胁人类生命和导致肢体残疾的主要疾病之一。随着新的辅助化疗的应用，影像学技术以及外科重建术的发展，保肢治疗已成为四肢恶性骨肿瘤治疗的主要方法和发展方向，但如何使保留的肢体具备良好的功能仍是尚未解决的问题。本科对59例患者进行保肢手术，就保肢治疗中组织修复和功能重建的重要性等问题进行讨论。
1 资料与方法 1.1 一般资料
本组病例56 例，男35 例，女21例；年龄9～60岁，平均19岁。均经穿刺或切开活检确诊。其中位于肱骨近端者9例，股骨远端30 例，胫骨近端17例。成骨肉瘤32例，软骨肉瘤17例，恶性骨巨细胞瘤3例，转移瘤4例。按照Enneking方法分期，Ⅰb期6例，Ⅱa期24例，Ⅱb期29例。
1.2 治疗方法 1.2.1 术前准备
术前对患者行正规化疗方案1～2个疗程，多采用联合化疗。对
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四肢骨骼系统恶性肿瘤保肢治疗的组织修复及功能重建
