Shih Hsin-Nung, Shih Lih-Yuann
Department of Orthopedic Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taipei.
Chang Gung Med J. 2005 Jun;28(6):411-20.
Wide resection and mobile joint reconstruction are preferable for treating an osteosarcoma around the knee. In certain situations, resection arthrodesis or an amputation is suggested.
During the past decade, 86 patients with an osteosarcoma around the knee were treated surgically in our institution. Wide resection and endoprosthetic reconstruction were performed in 35 patients, resection arthrodesis was performed in 36 patients, and an amputation was performed in 15 patients. The oncological and functional results were compared. Special attention was paid to the indications, techniques, and complications of patients receiving resection arthrodesis.
Extensive tumor involvement was the main reason, followed by inappropriate previous treatment, for precluding mobile joint reconstruction. The local recurrence rates were similar among the 3 groups (11.4% for the endoprosthetic group, 11.1% for the arthrodesis group, and 6.7% for the amputation group). The 5-year survival rate was 39% for the arthrodesis group, which was significantly lower than that of the endoprosthetic group (60%, p = 0.040), although it was higher than that of the amputation group (13%, p = 0.056). Major complications were found in 7 patients receiving resection arthrodesis (7/24, 29%), and these included nonunion, infection, and allograft fracture. Functional results for the arthrodesis patients were inferior to those of the endoprosthetic patients, but most patients were grateful for preservation of the limb despite certain handicaps.
The importance of early and proper planning of treatment cannot be over-stressed when treating osteosarcomas. Resection arthrodesis offers a durable reconstruction alternative to amputation in a special group of patients when extensive resection precludes mobile joint reconstruction.
广泛切除和可活动关节重建是治疗膝关节周围骨肉瘤的优选方法。在某些情况下，建议行切除关节融合术或截肢术。
在过去十年间，我院对86例膝关节周围骨肉瘤患者进行了手术治疗。35例行广泛切除和人工关节置换重建，36例行切除关节融合术，15例行截肢术。比较了肿瘤学和功能学结果。特别关注了接受切除关节融合术患者的适应证、技术和并发症。
广泛的肿瘤累及是妨碍可活动关节重建的主要原因，其次是既往治疗不当。三组的局部复发率相似（人工关节置换组为11.4%，关节融合术组为11.1%，截肢组为6.7%）。关节融合术组的5年生存率为39%，虽高于截肢组（13%）但显著低于人工关节置换组（60%，p = 0.040）。接受切除关节融合术的7例患者（7/24，29%）出现了严重并发症，包括骨不连、感染和同种异体骨骨折。关节融合术患者的功能结果不如人工关节置换患者，但尽管有一定功能障碍，大多数患者仍对保肢心怀感激。
治疗骨肉瘤时，早期和恰当的治疗规划至关重要。对于因广泛切除而无法进行可活动关节重建的特殊患者群体，切除关节融合术为截肢提供了一种持久的重建选择。
