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目的评价酒精灭活在重建恶性骨肿瘤骨缺损中的疗效,并分析影响疗效的相关因素。方法回顾性分析1995年1月至2013年6月,我科对53例恶性骨肿瘤患者进行酒精灭活再植治疗。平均年龄17.7(9~49)岁。其中股骨下段23例,股骨中段2例,胫骨上段20例,胫骨下段3例,肱骨上段3例,骶骨、髂骨各1例;Enneking分期II b期48例,III期5例;骨肉瘤44例,尤文肉瘤6例,横纹肌肉瘤、软骨肉瘤、非霍奇金淋巴瘤各1例。术后疗效评价采用(musculoskeletal tumor society system,MSTS)功能评分和(international society of limb salvage,ISOLS)影像评分。统计并分析各因素与术后功能、生存率的相关性。结果随访13~216(平均55)个月。广泛切除39例,边缘切除14例。灭活回植的瘤段平均长度为16.3(5~26)cm。II b期的48例中11例出现肿瘤复发,肺转移9例,转移率18.8%,6例死亡,5例带瘤生存;44例骨肉瘤中7例出现肿瘤复发,肺转移6例,转移率13.6%,术后3年生存35例。5年生存率为42.5%,其中骨肉瘤5年生存率为54.5%。30例灭活骨得以长期存在,其3年总生存率57%(30/53),保肢率68%(36/53)。术后切口感染4例(7.6%),骨折、内固定断裂5例(9.4%,5/53),内固定断裂2例(3.8%,2/53)。灭活骨延迟愈合、不愈合共8例(15.1%,8/53)。MSTS功能评分19~33(平均27)分;ISOLS影像评分22~31(平均26)分。单因素分析提示:(1)灭活瘤段长度与骨痂出现率、骨痂出现时间、术后复发率、总生存率、MSTS评分、ISOLS评分均具有相关性(P<0.05);(2)肿瘤分期与术后复发率具有相关性(P<0.05);(3)是否保留关节与MSTS评分具有相关性(P<0.05);(4)病程、肿瘤分期(P=0.026)、发病部位与患者3年生存率具有相关性(P<0.05)。多因素分析提示:灭活瘤段长度、病程长短、肿瘤分期是影响总生存率的独立因素(P<0.05)。结论酒精灭活瘤段骨治疗恶性骨肿瘤骨缺损能提高患者的生存率、减少灭活瘤段长度、保留关节有利于提高患者功能。灭活瘤段长度、病程长短、肿瘤分期是影响总生存率的独立因素。
Objective To evaluate the efficacy of alcohol inactivation in reconstructing bone defects of malignant bone tumors and to analyze the related factors that affect the efficacy. Methods Retrospective analysis of January 1995 to June 2013, our department of 53 cases of malignant bone tumor in patients with alcohol inactivation replantation. The average age of 17.7 (9 to 49) years old. There were 23 cases of inferior femur, 2 cases of middle femur, 20 cases of upper tibia, 3 cases of lower tibia, 3 cases of upper humerus, 1 case of sacrum and ilium, 48 cases of stage IIb and 5 cases of stage III and 5 cases of osteosarcoma Cases, Ewing’s sarcoma in 6 cases, rhabdomyosarcoma, chondrosarcoma, non-Hodgkin’s lymphoma in 1 case. Postoperative evaluation of musculoskeletal tumor society system (MSTS) score and (international society of limb salvage, ISOLS) imaging score. Statistics and analysis of various factors and postoperative function, the correlation between the survival rate. Results The follow-up ranged from 13 to 216 (average 55) months. Broad excision in 39 cases, marginal resection in 14 cases. Inactivated replantation of the tumor segment average length of 16.3 (5 ~ 26) cm. Among the 48 cases of stage IIb, there were 11 cases of tumor recurrence, 9 cases of lung metastasis, 18.8% of metastasis, 6 cases died and 5 cases of tumor-bearing survival. Among 44 cases of osteosarcoma, 7 cases had tumor recurrence, 6 cases lung metastasis, Rate of 13.6%, 35 patients survived 3 years after surgery. 5-year survival rate was 42.5%, of which 5-year survival rate of osteosarcoma was 54.5%. Thirty cases of inactivated bone were present for a long time. The 3-year overall survival rate was 57% (30/53) and the limb salvage rate was 68% (36/53). Incision infection occurred in 4 cases (7.6%), fracture, internal fixation fracture in 5 cases (9.4%, 5/53) and internal fixation fracture in 2 cases (3.8%, 2/53). Delayed inactivation of bone healing, nonunion a total of 8 cases (15.1%, 8/53). MSTS score 19 to 33 (mean 27); ISOLS video score 22 to 31 (average 26). Univariate analysis showed that: (1) The length of inactivated tumor segment was correlated with the occurrence of callus, callus appearance time, postoperative recurrence rate, overall survival rate, MSTS score and ISOLS score (P <0.05) ) (P <0.05); (3) Whether the joint was preserved and the MSTS score was correlated (P <0.05); (4) The course of the disease, tumor stage (P = 0.026) And 3-year survival rate of patients was correlated (P <0.05). Multivariate analysis showed that the length of inactivated tumor, duration of disease and tumor stage were the independent factors affecting the overall survival rate (P <0.05). Conclusions The alcohol-killed tumor segment can improve the survival rate of patients with malignant bone tumor and reduce the length of the inactivated tumor segment. It is helpful to keep the joint in improving patient’s function. Inactivated tumor length, duration of disease, tumor staging is an independent factor affecting the overall survival rate.