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目的探讨采用广泛切除及功能重建手术方法治疗股骨上段恶性骨肿瘤的临床疗效。方法回顾分析1987年1月-2007年12月手术治疗的62例股骨上段恶性骨肿瘤患者临床资料。男29例,女33例;年龄14～73岁,中位年龄35岁。原发性肿瘤41例,病程0.5～14.0个月,平均2.5个月;其中骨肉瘤16例,纤维肉瘤7例,软骨肉瘤6例,恶性纤维组织细胞瘤6例,间叶源性肉瘤4例,尤文肉瘤1例,血管肉瘤1例;按Enneking分期:ⅠB期3例,ⅡA期2例,ⅡB期35例,Ⅲ期1例。转移性肿瘤21例,其中16例有恶性肿瘤史;病程0.1～28.0个月,平均3.4个月。术中行根治性切除9例,广泛性切除39例,边缘性切除14例。39例行人工假体重建(假体组),14例行假体异体骨复合物(allograft-prostheticcomposite,APC)重建(APC组),8例截肢,1例最终行全股骨人工关节置换手术。结果术后切口均Ⅰ期愈合。26例因肿瘤远处转移死亡,术后生存16～56个月,平均28个月;36例生存患者随访时间28～221个月,平均64个月。原发性肿瘤术后局部复发率为4.88%(2/41)。术后假体组出现股骨头脱位2例,假体柄断裂1例,髋部疼痛3例,髋臼磨损3例,假体柄周围松动5例;APC组出现移植骨与宿主骨不愈合3例,髋臼磨损1例。末次随访时,假体组患肢按国际骨与软组织肿瘤协会(MSTS)功能评分为77.69%±6.50%,APC组为85.71%±7.45%,差异有统计学意义(P<0.001)。结论股骨上段恶性骨肿瘤广泛切除后,可获得较好的局部控制;肿瘤切除后APC重建的患肢功能优于人工假体重建。
Objective To investigate the clinical effect of extensive excision and functional reconstruction surgery for the treatment of malignant bone tumors in the upper femur. Methods The clinical data of 62 patients with malignant bone tumors of the upper femur surgically treated from January 1987 to December 2007 were retrospectively analyzed. 29 males and 33 females; aged 14 to 73 years, with a median age of 35 years. 41 cases of primary tumors, the duration of 0.5 to 14.0 months, an average of 2.5 months; of which 16 cases of osteosarcoma, fibrosarcoma in 7 cases, 6 cases of chondrosarcoma, malignant fibrous histiocytoma in 6 cases, mesenchymal sarcoma in 4 cases , 1 case of Ewing’s sarcoma and 1 case of angiosarcoma. According to Enneking classification, 3 cases were stage IB, 2 cases were stage IIA, 35 cases were stage IIB, and 1 case was stage III. 21 cases of metastatic tumors, of which 16 cases of malignant tumor history; duration of 0.1 ~ 28.0 months, an average of 3.4 months. Intraoperative radical resection in 9 cases, extensive resection in 39 cases, marginal resection in 14 cases. 39 cases of artificial prosthesis reconstruction (prosthesis group), 14 cases of allograft-prosthetic composite (APC) reconstruction, 8 cases of amputation and 1 case of final total hip arthroplasty. Results The incisions healed in the first stage. Twenty-six patients died of distant metastasis. The patients survived for 16-56 months (average 28 months). The survival time of 36 patients was 28 221 months (average 64 months). The local recurrence rate of primary tumor was 4.88% (2/41). There were 2 cases of femoral head dislocation, 1 case of fracture of prosthesis, 3 cases of hip pain, 3 cases of acetabular wear and 5 cases of loosening around the prosthesis in the postoperative prosthesis group. There was grafting and host nonunion in APC group 3 Cases, acetabular wear in 1 case. At the last follow-up, the prosthesis group had a functional score of 77.69% ± 6.50% according to the International Association of Bone and Soft Tissue Tumors (MSTS), and 85.71% ± 7.45% in the APC group (P <0.001). Conclusions After extensive excision of malignant bone tumors in the upper femur, better local control can be obtained. The function of APC reconstructed limbs after tumor resection is better than artificial prosthesis reconstruction.