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目的探讨单纯使用CT测量肢体骨肉瘤髓内长度的准确性。方法回顾性对81例肢体骨肉瘤患者髓内长度进行CT测量,其中男46例,女35例,年龄10~60岁,中位年龄15岁,肿瘤位于股骨下段45例,胫骨上段23例,肱骨上段10例,股骨上段2例,胫骨下段1例,从工作站CT上测量关节面到肿瘤边界的长度,股骨上段肿瘤测量大转子尖到肿瘤边界的长度,所有患者均接受瘤段截除术,术后测量肿瘤的病理长度,将CT和病理测量的长度进行比较和统计学分析。结果81例患者测量的CT长度与病理长度进行配对t检查,t=5.185,P<0.01,二者差异有统计学意义;CT测量与病理测量误差在1 cm之内的52例,准确率为64.2%,将此52例的CT长度与病理长度进行配对t检查,t=-0.51,P=0.959,二者差异无统计学意义。其余29例误差超过1 cm的病例CT测量均比病理测量长,平均误差110(16~262)mm,对CT异常而病理无肿瘤的那部分截除髓腔测CT值及病理组织学分析,CT值显示增强前为-28~45HU,增强后为-10~87 HU,组织学分析显示CT测量超出的部分髓腔组织学为红细胞系、白细胞系及血小板系造血细胞增生,未见肿瘤细胞。结论单纯使用CT测量骨肉瘤髓腔内长度准确性欠佳,不能区分肿瘤与增生骨髓,需要综合其他影像方式来判断骨肉瘤髓内长度以指导保肢手术。
Objective To investigate the accuracy of measuring the intramedullary length of limb osteosarcoma using CT alone. Methods The intramedullary length of 81 patients with osteosarcoma were retrospectively reviewed. Among them, 46 were males and 35 females, aged from 10 to 60 years with a median age of 15 years. The tumors were located in 45 cases of the lower femur, 23 cases of the upper tibia, 10 cases of the upper humerus, 2 cases of the upper femur and 1 case of the lower tibia. The length of the articular surface to the tumor boundary was measured from the workstation CT. The length of the greater trochanter from the upper femur to the borderline of the tumor was measured. All patients underwent tumor resection The pathological length of the tumor was measured after surgery. The length of CT and pathological measurement were compared and statistically analyzed. Results The length of CT and the path length of 81 patients were matched with t test, t = 5.185, P <0.01, the difference was statistically significant. The accuracy of CT measurement and pathological measurement was within 1 cm, the accuracy was 64.2%, the 52 cases of CT length and pathological length paired t test, t = -0.51, P = 0.959, the difference was not statistically significant. The remaining 29 cases with error of more than 1 cm were longer than the pathological measurement of CT measurement, with an average error of 110 (16 ~ 262) mm. The CT value and pathological histological analysis of the tumor with no pathological tumor were excluded. The CT values showed -28 ~ 45HU before enhancement and -10 ~ 87 HU after enhancement. Histological analysis showed that some of the medullary cavity histopathology beyond the measurement of CT were erythrocyte, leucocyte and platelet hematopoietic cells proliferation, no tumor cells . Conclusions The accuracy of using CT only to measure the length of osteosarcoma in the medullary cavity is not good enough to differentiate the tumor from the hyperplastic bone marrow. It is necessary to determine the intramedullary length of the osteosarcoma based on other imaging methods to guide the limb salvage surgery.