Fitzgerald R H, Brewer N S, Dahlin D C
J Bone Joint Surg Am. 1976 Dec;58(8):1146-8.
Treatment of carcinomatous degeneration in patients with chronic osteomyelitis requires differentiation between benign, penetrating epithelioma and invading, low-grade squamous-cell carcinoma. Although most lesions are low grade, analysis of the case histories of twenty-three patients treated at the Mayo Clinic indicates that these tumors do metastasize. When malignant-appearing epithelium invading bone is identified, ablative surgery is indicated. Inadequate surgical treatment resulted in the deaths of two patients in our series. Routine regional lymphadenectomy at the time of amputation seems unnecessary. Regional lymphadenopathy persisting for six to twelve weeks after amputation warrants surgical intervention. With prompt, aggressive surgical treatment, the prognosis for patients with squamous-cell carcinoma in an osteomyelitic cavity is good.
慢性骨髓炎患者发生癌性退变的治疗需要区分良性、浸润性上皮瘤与侵袭性、低级别鳞状细胞癌。虽然大多数病变为低级别，但对梅奥诊所治疗的23例患者的病历分析表明，这些肿瘤确实会发生转移。当识别出侵袭骨骼的恶性上皮时，应进行切除手术。在我们的系列病例中，手术治疗不充分导致两名患者死亡。截肢时常规进行区域淋巴结清扫似乎没有必要。截肢后区域淋巴结肿大持续6至12周需要手术干预。通过及时、积极的手术治疗，骨髓炎腔内鳞状细胞癌患者的预后良好。
