21例胫骨近端骨肉瘤保肢治疗临床分析

目的：探讨胫骨上端骨肉瘤保肢手术中使用人工关节重建的疗效和并发症。方法：回顾性分析2000年6月-2010年6月对21例胫骨上段骨肉瘤患者行根治性切除人工关节重建手术的临床资料，其中男性13例，女性8例，年龄21—62岁，平均34．1岁。依据Enneking分期：ⅡA期12例、ⅡB期9例。均采用广泛性边缘切除手术治疗。所有患者均接受术前、术后化疗。结果：1例患者发生术后胫前肌群坏死。所有患者均随访6—72个月，平均45．1个月。ⅡA期12例患者中，1例因肺转移死亡（占8．3％），局部复发1例，行股骨下段截肢，10例无病生存；ⅡB期9例，4例死亡，5例存活；Enneking分期明显影响预后。结论：胫骨上段人工关节重建对胫骨上段骨肉瘤的保肢治疗具有良好的疗效。

Analysis the Therapy for Resection of Proximal Tibia Bone Osteosarcoma

Objective： To evaluate the efficacy and complications of osteoarticular allografts in the limb salvage of the proximal tibia .Methods： The clinical data of 21 patients with osteoarticular allografts of the proximal tibia underwent osteoarticular allografts from June 2000 to June 2010,13 males and 8 females,aged 15-78 years old （ averaged, 34.1years）,were analyzed retrospectivelv. All the patients underwent the marginal resection.According to the Enneking system, 13 patients were classified into Ⅱ A, and 9 patients into Ⅱ B.All patients accepted chemotherapy before and after surgery. Results： All cases were followed up from 6 to 72 months （averaged, 45.1 months）. In 12 cases of Ⅱ A,one case （8.3%）developed pulmonary metastasis and died.One had a local recurrence,and underwent amputation at the lower part of the femur. Ten cases remained continuously disease-free.In 9 cases of Ⅱ B, 4 died , and 5 remained disease-free. Euncking staging was significantly affecting prognosis in patients. Conclusion： The surgical operation combined with the osteoarticular allografts is an ideal treatment method for the proximal tibia osteosarcomas.