Suk Kyung-Soo, Shin Kyoo-Ho, Hahn Soo-Bong
Department of Orthopaedic Surgery College of Medicine, Kyung Hee University, Seoul, Korea.
Clin Orthop Relat Res. 2002 Apr(397):385-93. doi: 10.1097/00003086-200204000-00045.
Limb salvage, using original low heat-treated tumor-bearing bone and a conventional joint prosthesis, was done in six patients with malignant tumors of the proximal humerus (one patient with chondrosarcoma and five patients with osteosarcoma) and in six patients with tumor of the proximal femur (two patients with malignant spindle cell sarcoma and four patients with osteosarcoma). Wide excision of the lesion was done and the tumor and surrounding soft tissues were removed. The excised bone was treated with heat and the prosthesis was inserted into the treated bone and fixed with cement. This construct was reinserted into the original site and anchored to the host bone with a plate. The overall union rate of the low heat-treated bone with normal host bone was 91.7%, and the mean union time was 4.6 months (range, 3-7 months) after surgery. The functional result of the proximal femur and proximal humerus were 76.7% and 56.8%, respectively, using the Musculoskeletal Tumor Society functional evaluation system. Complications included hip dislocation in one patient, fracture of the low heat-treated bone in two patients, and absorption of the low heat-treated bone of the humerus in four of six patients. The 5-year survival rate of the low heat-treated tumor-bearing bone was 83.3% using Kaplan-Meier survival analysis. Based on the results of this study, limb salvage using original low heat-treated tumor-bearing bone seems to be effective in treating primary bone sarcoma with high survival and acceptable complication rates, circumventing the complications of allograft bone.
对6例肱骨近端恶性肿瘤患者（1例软骨肉瘤患者和5例骨肉瘤患者）以及6例股骨近端肿瘤患者（2例恶性梭形细胞肉瘤患者和4例骨肉瘤患者）采用保留肢体的方法，即使用原低热处理的带瘤骨和传统关节假体。对病变进行广泛切除，切除肿瘤及周围软组织。切除的骨进行热处理，将假体插入处理后的骨并用骨水泥固定。将该结构重新植入原部位，并用钢板固定于宿主骨。低热处理骨与正常宿主骨的总体愈合率为91.7%，术后平均愈合时间为4.6个月（范围3 - 7个月）。采用肌肉骨骼肿瘤学会功能评估系统，股骨近端和肱骨近端的功能结果分别为76.7%和56.8%。并发症包括1例髋关节脱位、2例低热处理骨骨折以及6例肱骨低热处理骨吸收患者中的4例。采用Kaplan - Meier生存分析，低热处理带瘤骨的5年生存率为83.3%。基于本研究结果，使用原低热处理带瘤骨保留肢体似乎对治疗原发性骨肉瘤有效，生存率高且并发症发生率可接受，避免了同种异体骨的并发症。
