目的探讨2006年9月至2010年6月应用微波消融治疗股骨及胫骨普通骨肉瘤的疗效及并发症。方法本组共15例,男9例、女6例,中位年龄16(5~52)岁。发病部位:股骨远端6例、股骨干5例、胫骨近端4例,Enneking分期均为ⅡB期。所有患者经活检确诊后,术前多药联合化疗1周期。手术按恶性肿瘤广泛切除原则显露肿瘤,对瘤段骨行多根微波天线矩阵式微波消融。消融完成后清除坏死肿瘤组织,5例行自体或异体腓骨移植+钢板内固定、3例行骨水泥填充+钢板内固定、2例行自体或异体腓骨移植复合骨水泥填充+钢板内固定、3例单纯钢板内固定、2例单纯髓内钉内固定术。术后同术前化疗方案行4周期辅助化疗。术后2年内每3个月,术后2年以上每6个月,术后5年以上每年复查1次,随访截至时间2013年12月。结果所有病例均获(51±20)个月的随访。术后复发并肺转移4例(复发时间术后平均10.2个月)、单纯肺部转移1例,该5例全部死亡;其余10例无瘤生存。复发率26.7%,3例为骨内复发,1例软组织复发;肺部转移率33.3%。2年和5年总生存率分别为73%和53%。6例出现病理骨折及内固定断裂,骨折率40%。术后半年评价患膝关节屈伸活动均接近正常,但长期随访出现病理骨折者的肢体功能明显恶化,术后3年病理骨折组评分明显低于无骨折组,差异有统计学意义(P<0.01)。结论微波消融治疗下肢长骨骨肉瘤总体生存情况与国内目前整体治疗效果相当;由于灭活骨愈合过程漫长,行植骨及内固定重建后发生病理骨折风险较高;对下肢临关节骨肉瘤,瘤段骨扩大切除人工假体置换可能更为适宜。 Objective To investigate the efficacy and complications of microwave ablation of common femoral and tibial osteosarcoma from September 2006 to June 2010. Methods The group of 15 cases, 9 males and 6 females, the median age of 16 (5 to 52) years old. Pathogenesis: distal femur in 6 cases, 5 cases of femoral shaft, proximal tibia in 4 cases, Enneking staging were Ⅱ B period. All patients diagnosed by biopsy, preoperative multi-drug combination chemotherapy 1 cycle. Surgery according to the principle of extensive resection of malignant tumor revealed on the tumor segment multiple microwave antenna matrix microwave ablation. After the ablation was completed, the necrotic tumor tissues were removed, 5 cases were treated with autologous or allogeneic fibula transplantation and plate fixation, 3 cases were treated with bone cement filling and plate fixation, 2 cases were treated with autologous or allogeneic fibula transplantation and bone cement filling and plate fixation, 3 Cases of simple internal fixation, 2 cases of simple intramedullary nailing. Postoperative chemotherapy with 4 cycles of adjuvant chemotherapy. Every 3 months after operation within 2 years, every 6 months after operation for more than 2 years and once every 5 years after operation. The follow-up time was December 2013. Results All cases were followed up for 51 ± 20 months. Four patients had recurrence and lung metastasis (average 10.2 months after the recurrence). Only one patient had lung metastasis. All of the five patients died and the remaining 10 patients had no tumor. The recurrence rate was 26.7%. Three cases were intraosseous and one case had soft tissue recurrence. The lung metastasis rate was 33.3%. The 2-year and 5-year overall survival rates were 73% and 53%, respectively. 6 cases of pathological fracture and internal fixation fracture, fracture rate of 40%. The six months postoperative evaluation of knee joint flexion and extension activities were close to normal, but long-term follow-up pathological fracture of the limb function was significantly worse, three-year postoperative pathological fracture score was significantly lower than the non-fracture group, the difference was statistically significant (P <0.01 ). Conclusion The overall survival of long bone osteosarcoma in the lower extremity treated with microwave ablation is similar to that of the current overall treatment in China. Due to the long process of in-bone healing, the risk of pathological fracture is high after reconstructive grafting and internal fixation. Expansion of segmental bone prosthesis replacement may be more appropriate.