累及腓骨近端原发恶性肿瘤的保肢手术治疗Limb salvage for primary malignant tumors involving the proximal fibula
付卫平;李甲振;张岩;卢新昌;张翼;刘永奎;
摘要(Abstract)：
[目的]回顾性分析累及腓骨近端原发恶性肿瘤患者的病历资料,探讨其保肢技术,总结其肿瘤学结果、并发症及术后功能情况。[方法]2002年10月~2014年12月,共有14例累及腓骨近端原发恶性肿瘤患者于本院接受保肢治疗,男9例,女5例;年龄9~61岁,平均23.20岁。骨肉瘤9例,软骨肉瘤2例,尤文肉瘤2例,纤维肉瘤1例。14例患者均首诊于本院,术前均行穿刺活检明确病理,均符合并接受保肢手术治疗,其中9例骨肉瘤患者接受了4~6周期新辅助化疗(术前2周期),化疗方案以阿霉素、顺铂、大剂量氨甲喋呤、异环磷酰胺为主。依据Enneking分期,处于ⅡA期病例4例,采用Malawer-Ⅰ型切除。ⅡB期病例10例采用Malawer-Ⅱ型切除。[结果]随访时间18~164个月,平均36.20个月。5例术后局部复发,其中Malawer-Ⅱ型切除的2例(2/10),Malawer-Ⅰ型切除的3例(3/4)。4例患者死于肺转移,其中Malawer-Ⅱ型切除的2例(2/10),Malawer-Ⅰ型切除的2例(2/4)。所有患者经膝关节股二头肌肌腱及外侧副韧带止点重建后,膝关节功能均稳定。对于腓总神经切除的患者佩戴踝关节外固定支具行走。多数患者疼痛缓解,不影响日常生活活动。国际骨肿瘤协会(musculoskeletal tumor society,MSTS)评分14~26分.平均21.9分(73%)。[结论]累及腓骨近端原发恶性肿瘤,由于其解剖学特点,多数发现时已处于Enneking分期ⅡB期,选择保肢技术时,应尽量获得足够的手术边界,以期获得良好的肿瘤学结果。
关键词(KeyWords)： 腓骨肿瘤;恶性;手术;复发
基金项目(Foundation): 河南省医学科技攻关项目(编号:201403023)
作者(Author): 付卫平;李甲振;张岩;卢新昌;张翼;刘永奎;
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DOI:
参考文献(References)：
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