四肢长骨恶性肿瘤并发骨折的手术时机及方法

摘 要： [目的] 探讨四肢长骨恶性肿瘤并发骨折的手术时机及手术方法。[方法] 回顾1996年6月～2003年10月收治的四肢长骨恶性肿瘤并发骨折17例, 其中骨肉瘤4例，骨巨细胞瘤3例，尤文氏肉瘤1例，造釉细胞瘤1例, 骨转移瘤8例。采用I期外固定并化疗， II期瘤段切除重建术4例；I期行肿瘤病灶清除功能重建术11例； I期截肢1例，II期截肢1例。[结果] 随访时间12～88个月，原发性恶性肿瘤9例中，肺转移死亡2例，其中1例局部复发；骨转移瘤8例中，死亡4例，其中1例局部复发。[结论] 化疗敏感的原发恶性肿瘤并发骨折主张优先考虑I期外固定并化疗， II期瘤段切除重建；化疗不敏感的骨巨细胞瘤及骨转移瘤并发骨折应I期行病灶清除功能重建。河南省洛阳正骨医院骨肿瘤科李东升
 
The methods and opportunity of operation for the malignant tumor intercurrent fracture of extremity LI Dongsheng ZHANG Zhiyong HUANG Manyu, et al. The department of bone tumor of Luoyang orthopaedics hospital (Henan Luoyang, 471002)
Abstract [Objective] To study the methods and opportunity of operation for the malignant tumor intercurrent fracture of extremity. [Methods] 17 cases of malignant tumor intercurrent fracture of extremity were reviewed in our hospital from June1996 to October 2003 in the study, including osteosarcoma 4 cases, giant cell tumor 3 cases, Ewing’ tumor 1 case, ameloblastoma of bone 1 case, bony metastases 8 cases. 4 cases treated with exterior fixation and chemotherapy in ⅠP(period) and reconstruction after tumor cutting in ⅡP(period), 11 cases treated tumor eliminate and reconstruction in ⅠP(period). 1 case amputed in ⅠP(period) and 1 cases amputed in ⅡP(period). [Result] All patients treated had been followed up from 12 to 88 months, 1 case occurred local recurrence, and 2 cases died because of lung metastases in the 9 cases of primary malignant tumor. While 1 case occurred local recurrence, and 4 cases died in the 8 cases of metastasis malignant tumor. [Conclusion] For the primary malignant tumors with fracture, which were sensitive to chemotherapy, should first take into account to exterior fixation and chemotherapy in ⅠP(period) and reconstruction after tumor cutting in ⅡP(period), while for the insensitive giant cell tumor and bony metastases with fracture should treat with tumor eliminate and reconstruction inⅠP(period).