摘要
目的探讨恶性骨肿瘤保肢手术并发症发生的原因及防治措施.方法采用微波原位灭活术和人工假体置换术对66例膝关节周围恶性肿瘤患者行保肢术,微波原位灭活38例,人工膝关节置换28例.在复习病历的基础上分析其手术并发症.结果微波原位灭活组随访11～67个月,平均29.6个月,其中12例死亡,3年生存率为65.8%;6例因感染、肿瘤局部复发等原因而截肢,保肢率为84.2%;出现了22例次不同种类的并发症,发生率为57.9%.人工膝关节置换组随访17～62个月,平均34.8个月,其中8例死亡,3年生存率为71.4%;2例因肿瘤局部复发而截肢,保肢率为92.9%;出现了9例次不同种类的并发症,发生率为32.1%.结论恶性骨肿瘤保肢术后局部复发率不高,但肺转移发生率较高并成为恶性骨肿瘤复发致死的主要原因.切口感染多发生在胫骨上端.微波原位灭活骨段骨折多发生于术后8～16个月.除局部复发和远处转移外,人工膝关节置换组的并发症发生率低于微波原位灭活组(P＜0.05).
Objective To analyze the causes of complications in the limb salvage operations for malignant bone tumors and explore the preventions and therapies for them.Methods 66 patients suffered from malignant bone tumors around the knee were treated with intraoperative microwave heliotherapy in situ (38 cases) and knee prosthesis replacement (28 cases).The cases history was reviewed and the complications were analyzed, respectively. Results In the intraoperative microwave heliotherapy group: The average follow-up was 29.6 months(11~67); 12 died. The three-year survival rate was 65.8%. Amputation was performed in 6 patients because of the infection and recurrence,and the limb salvage rate was 84.2%. Various complications occurred in 22 cases(57.9%). In the knee prosthesis replacement group: The average follow-up was 34.8 months(17~62); 8 died. The three-year survival rate was 71.4%. Amputation was performed in 2 patients due to recurrence. The salvage rate was 92.9%.Various complications occurred in 9 cases(32.1%). Conclusions The local tumor recurrence of malignant bone tumors is not more frequent than that of amputation. The lung metastases is the main cause of death of patients suffered from malignant bone tumors. The incision problems often happen in the upper end of tibia. The postoperative fractures of the devitalized bone often happen in 8~16 months. Except the recurrence and metastasis, the incidence rate of complications in the knee prosthesis replacement group is lower than that in the microwave heliotherapy group(P<0.05).
出处
《临床骨科杂志》
2005年第2期116-120,共5页
Journal of Clinical Orthopaedics
关键词
骨肿瘤
保肢手术
bone neoplasms
limb salvage operation
