膝关节周围骨肉瘤保肢手术疗效及预后分析

摘要

目的 探讨膝关节周围骨肉瘤保肢手术的临床疗效及患者预后生存状况.方法 回顾性分析1998年至2008年间保肢手术治疗的120例膝关节周围骨肉瘤患者临床资料,其中男75例,女45例;年龄5～48岁,平均18.9岁.股骨下端骨肉瘤78例,胫骨上端骨肉瘤42例,规范化疗85例,不规范化疗35例.应用统计学方法处理记录患者的资料,分析手术疗效及患者预后生存情况.结果 所有患者均获得随访,随访时间6～144个月,平均56.8个月.120例患者5年总生存率61.8％,12例患者再次截肢,规范化疗患者5年总生存率71.6％,不规范化疗患者5年总生存率40％,两者差异有统计学意义(P<0.01).骨与软组织肿瘤协会(musculoskeletal tumor society,MSTS)肢体功能评分平均25.47分,股骨下端和胫骨上端骨肉瘤保肢术后膝关节活动度两者差异无统计学意义,但膝关节伸直缺失胫骨上端较股骨下端肿瘤术后发生率高,差异有统计学意义(P=0.03).结论 保肢手术联合新辅助化疗是目前治疗膝关节周围骨肉瘤比较理想的选择,可以较好的保留部分关节功能和肢体外观,但并发症发生率较高,肿瘤局部复发和假体感染是导致再次截肢的主要原因.%Objective To investigate the clinical efficacy,limb function,survival and complication of patients treated limb-salvage surgery for osteosarcoma around the knee.Methods We retrospectively reviewed the clinical data for 120 patients with osteosarcoma around the knee who treated with limb-salvage surgery between1998 to 2008.The sample included 75 males and 45 females.The mean age of the patients was 18.9 years,ranged from 5 to 48 years.Osteosarcoma was diagnosed in the distal femur in 78 patients and in the proximal tibia in 42 patients.85 patients received standard chemotherapy,while 35 patients received non-standard chemotherapy.Statistical analyses were conducted to process and record patient data and analyze the surgery's efficacy,prognosis and survival rates.Results All patients were followed for 6 to 144 months,with a mean length of 56.8 months.Twelve of the 120 patients (10％)required secondary amputa-tion.The 5-year overall survival rate for the 120 patients was 61.8％.The 5-years overall survival rates were 71.6％ for patients treated with standard chemotherapy and 40％ for those treated with non-standard chemotherapy.There was a significant difference in survival rates between the treatments (P<0.01).The average MSTS score was 25.47 points. There was no significant difference in postoperative knee flexion between patients with tumor in the distal femur and tumor in the proximal tibia.However,there was a higher incidence of extensor lag in patients with tumor in the proxi-mal tibia than those with tumor in the distal femur,and the difference was significant (P=0.03).Conclusion Current-ly,limb-salvage surgery combined with neoadjuvant chemotherapy is the option for treating osteosarcoma around the knee.It can preserve knee function and appearance well,but has a relatively high incidence of complications.