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[目的]探讨踝关节侵袭性和恶性肿瘤的外科治疗方式及治疗效果。[方法]回顾性研究2006年1月~2013年8月期间18例踝关节侵袭性和恶性肿瘤的患者。男10例,女8例;平均年龄31.7岁(8~60岁)。恶性肿瘤12例,侵袭性肿瘤6例。肿瘤类型以骨肉瘤最多(5例),其次为骨巨细胞瘤4例。10例肿瘤发生在胫骨远端,7例位于腓骨远端,1例位于距骨。12例患者行不同方式的保肢治疗,6例患者行截肢治疗。[结果]平均随访40.3个月(12~90个月)。总体复发率16.7%。12例恶性肿瘤患者中,6例保肢患者生存率(3年83.3%,5年27.8%)与6例截肢患者生存率(3年83.3%,5年41.7%)相比差异无统计学意义。12例保肢患者术后踝关节平均功能评分(MSTS评分)为82.9%,患者的情绪接受评分最高(平均4.5分)。[结论]通过广泛的肿瘤切除辅以放化疗,可达到良好的局部控制和长期生存。保肢术能达到较高的功能评分,并提高患者心理接受程度。
[Objective] To investigate the surgical treatment of ankle joint aggressive and malignant tumors and its therapeutic effect. [Methods] A retrospective study of 18 patients with ankle-invasive and malignant tumors from January 2006 to August 2013 was performed. 10 males and 8 females; the average age was 31.7 years old (8 ~ 60 years old). 12 cases of malignant tumors, 6 cases of invasive tumors. The type of tumor was osteosarcoma (5 cases), followed by giant cell tumor of bone in 4 cases. Tumors occurred in 10 cases distal to the tibia, 7 in the distal fibula and 1 in the talus. Twelve patients underwent limb salvage in different ways, and six patients underwent limb amputation. [Results] The average follow-up period was 40.3 months (12 to 90 months). The overall recurrence rate was 16.7%. Among the 12 patients with malignant tumor, the survival rates of the 6 limb salvage patients (83.3% at 3 years and 27.8% at 5 years) were not significantly different from those of 6 cases with amputation (83.3% at 3 years and 41.7% at 5 years) . The average ankle joint function score (MSTS score) was 82.9% in 12 limb salvage patients, and the highest emotion acceptance score (average 4.5 points). [Conclusion] Good local control and long-term survival can be achieved through a wide range of tumor resection combined with chemoradiation. Limb salvage surgery to achieve a higher functional score, and improve the psychological acceptance of patients.