摘要
目的探讨计算机导航手术和传统手术对骨盆软骨肉瘤功能和肿瘤学结局的影响。方法回顾性分析2000年1月至2017年12月北京积水潭医院手术治疗的骨盆软骨肉瘤136例,男65例、女71例,年龄(46.07±13.37)岁(范围13~73岁);原发性120例、继发性16例,其中普通型软骨肉瘤109例(病理分化程度分级Ⅰ级7例、Ⅱ级83例、Ⅲ级19例)、去分化软骨肉瘤21例、间叶型3例、透明细胞型2例、黏液型1例;12例为多发骨软骨瘤病恶变;Enneking分期ⅠB期104例、ⅡB期32例;按解剖部位分类为骨盆Ⅰ区14例、Ⅱ区1例、Ⅲ区13例、Ⅰ+Ⅱ区16例、Ⅰ+Ⅳ区16例、Ⅱ+Ⅲ区47例、Ⅰ+Ⅱ+Ⅲ区25例、Ⅰ+Ⅱ+Ⅲ+Ⅳ区4例。所有病例按照切除边界分为囊内、边缘、广泛切除,计算机导航手术(导航组)45例、非导航手术组91例。比较两组患者人口学资料、术前肿瘤分期、手术特征、外科边界分类、肿瘤学指标、重建方法、术后并发症及骨与软组织肿瘤功能评分(Musculoskeletal Tumor Society score,MSTS)。结果导航组未发生计算机导航系统相关的手术并发症。导航组与非导航组术后随访时间分别为(68.56±37.82)个月(范围6~197个月)和(76.85±52.60)个月(范围5~225个月)。导航组和非导航组MSTS分别为(25.43±2.854)和(24.56±4.193)分,差异无统计学意义(t=1.191,P=0.237)。导航组边缘切除10例、广泛切除35例,非导航组囊内切除12例、边缘切除32例、广泛切除47例,差异有统计学意义(χ^(2)=10.977,P=0.004)。导航组术后局部复发4例(8.9%,4/45),非导航组20例(21.9%,20/91),差异有统计学意义(χ^(2)=4.040,P=0.046);导航组复发患者最终截肢2例、再次切除2例,非导航组最终截肢6例、再次切除14例。导航组3例(7%,3/45)发生远处转移,非导航组18例(20%,18/91),差异有统计学意义(χ^(2)=4.478,P=0.034)。导航组和非导航组术后五年生存率分别为93.3%、72.6%,三年、五年无进展生存率为91.1%、84.4%和74.8%、62.7%,差异均有统计学意义(χ^(2)=5.081,P=0.024;χ^(2)=6.800,P=0.009)。导航组ⅠB期肿瘤五年生存率为96.7%、非导航组为84.5%,差异有统计学意义(χ^(2)=3.897,P=0.048);导航组ⅡB期肿瘤五年生存率为75.0%、非导航组为35.0%,差异无统计学意义(P>0.05)。术后并发症包括术后感染15例、深静脉血栓形成16例、双下肢不等长14例、假体脱位2例、淋巴水肿2例、疝气1例及异体骨吸收1例,两组各并发症发生率的差异无统计学意义(P>0.05)。结论计算机导航辅助骨盆软骨肉瘤切除手术相较于传统手术有利于获得安全的肿瘤外科边界,降低肿瘤局部复发率从而有效改善患者生存预后。
Objective To explore the effects of computer-navigated surgery and traditional surgery on the functional and oncological outcomes of pelvic chondrosarcoma.Methods Retrospective analysis of 136 cases of pelvic chondrosarcoma surgically treated at Beijing Jishuitan Hospital from January 2000 to December 2017.There were 65 males and 71 females with an average age of 46.07±13.37 years(range 13-73 years).There were 120 primary cases and 16 secondary cases,of which 109 cases were ordinary chondrosarcoma(7 cases with pathological differentiation gradeⅠ,83 cases with gradeⅡ.There were 109 cases of common type chondrosarcoma(7 cases of pathological differentiation grade I,83 cases of gradeⅡ,19 cases of gradeⅢ),21 cases of dedifferentiated chondrosarcoma,3 cases of mesenchymal type,2 cases of clear cell type,1 case of mucinous type;12 cases of malignant degeneration of multilocular chondrosarcoma of bone;104 cases of Enneking staging stage IB,32 cases of stageⅡB.According to the pelvis zone classification,there were 14 cases of pelvic zoneⅠ,1 case of zoneⅡ,13 cases of zoneⅢ,16 cases of zoneⅠ+Ⅱ,16 cases of zoneⅠ+Ⅳ,47 cases of zoneⅡ+Ⅲ,25 cases of zone I+Ⅱ+Ⅲ,25 cases of zoneⅠ+Ⅱ+Ⅲ,4 cases of zoneⅠ+Ⅱ+Ⅲ+Ⅳ.All cases were classified as intracapsular,marginal,or wide resection according to the resection boundary classification.There were 45 cases in computer-navigated surgery(navigated group)and 91 cases in non-navigated surgery group.The demographic data,preoperative tumor staging,surgical characteristics,surgical boundary classification,oncological indexes,reconstruction methods,postoperative complications,and bone and soft tissue tumor function score(Musculoskeletal Tumor Society score,MSTS)were compared between the two groups.Results No surgical complications related to the computerized navigation system occurred in the navigation group.The postoperative follow-up time was 68.56±37.82 months(range 6-197 months)and 76.85±52.60 months(range 5-225 months)for the navigation and non-navigation groups,respectively.The MSTS was 25.43±2.85 and 24.56±4.19 points in the navigation and non-navigation groups,respectively,with no significant difference(t=1.191,P=0.237).There were 10 cases of marginal resection and 35 cases of wide resection in the navigation group,and 12 cases of intracapsular resection,32 cases of marginal resection and 47 cases of wide resection in the non-navigation group with significant difference(χ^(2)=10.977,P=0.004).There were 4 cases(8.9%,4/45)of local recurrence after surgery in the navigation group and 20 cases(21.9%,20/91)in the non-navigation group,with significant difference(χ^(2)=4.040,P=0.046).There were 2 cases of final amputation and 2 cases of re-excision with recurrence in the navigation group and 6 cases of final amputation and 14 cases of re-excision in the non-navigation group.Distant metastases occurred in 3 cases(7%,3/45)in the navigation group and 18 cases(20%,18/91)in the non-navigation group wtih significant difference(χ^(2)=4.478,P=0.034).The five-year postoperative survival rates of the navigation and non-navigation groups were 93.3%and 72.6%,and the three-and five-year progression-free survival rates were 91.1%and 84.4%and 74.8%and 62.7%,respectively,with significant differences(χ^(2)=5.081,P=0.024;χ^(2)=6.800,P=0.009).The five-year survival rate of stage IB tumors was 96.7%in the navigation group and 84.5%in the non-navigation group with significant difference(χ^(2)=3.897,P=0.048);the five-year survival rate of stageⅡB tumors was 75.0%in the navigation group and 35.0%in the non-navigation group with no significant difference(P>0.05).Postoperative complications included 15 cases of postoperative infection,16 cases of deep vein thrombosis,14 cases of double lower limb inequality,2 cases of prosthesis dislocation,2 cases of lymphedema,1 case of hernia and 1 case of allograft bone resorption.There was no significant difference of complication rates between the two groups(P>0.05).Conclusion Computer navigation-assisted resection of pelvic chondrosarcoma was better in obtaining a safe surgical border of the tumor compared with traditional surgery,reducing the rate of local recurrence of the tumor and thus effectively improved the survival and prognosis of patients.
作者
李卓宇
刘巍峰
邓志平
金韬
李远
蒋协远
鱼锋
张清
牛晓辉
Li Zhuoyu;Liu Weifeng;Deng Zhiping;Jin Tao;Li Yuan;Jiang Xieyuan;Yu Feng;Zhang Qing;Niu Xiaohui(Department of Orthopedic Oncology Surgery,Beijing Jishuitan Hospital,Capital Medical University(Peking University Fourth School of Clinical Medicine),Beijing 100035,China;National Centre for Orthopaedics,Beijing 100035,China;Beijing Institute of Traumatology and Orthopaedics,Beijing 100035,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2024年第10期676-684,共9页
Chinese Journal of Orthopaedics
基金
国家重点研发计划(2023YFB4706300,2021YFC2400500)
北京市自然科学基金(L212042)
北京积水潭医院"学科骨干"计划专项(XKGG202105)
北京积水潭医院院级科研基金(2023OSR-GCZχ202206)。
