Jain R, Grimer R J, Carter S R, Tillman R M, Abudu A A
Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital, Bristol Road South, Birmingham B31 2AP, UK.
Eur J Surg Oncol. 2005 Nov;31(9):1025-8. doi: 10.1016/j.ejso.2005.07.014. Epub 2005 Sep 12.
To review the oncological and functional outcome in 80 patients who underwent disarticulation of the hip as part of their treatment.
Eighty patients had disarticulation, of whom 46 had a bone sarcoma and 34 a soft tissue sarcoma. In 42 patients the operation was done as the first definitive surgical procedure for that patient. In 38 patients the disarticulation followed local recurrence after unsuccessful limb salvage, three of these patients had palliative amputations already having metastatic disease. All patients had adjuvant therapy when appropriate.
The overall survival of the patients following the amputation was 56% at 1 year, 39% at 2 years, 27% at 5 years and 21% at 10 years. The 5-year survival of patients having the amputation as a primary procedure was 32%, for those with local recurrence it was 25% whilst for those with a palliative amputation it was nil. Local recurrence developed in 10 patients following the amputation, and was related to close margins of excision; all of these patients subsequently died. Function was on the whole poor, with only one surviving patient regularly using an artificial limb.
Disarticulation of the hip remains a disabling procedure usually carried out for high grade sarcomas with extensive involvement of bone and soft tissues in the thigh. Long term survival is possible if wide margins of excision can be achieved.
回顾80例接受髋关节离断术作为其治疗一部分的患者的肿瘤学及功能预后情况。
80例患者接受了髋关节离断术，其中46例患有骨肉瘤，34例患有软组织肉瘤。42例患者的手术是该患者的首次确定性外科手术。38例患者在保肢手术失败后出现局部复发后进行了髋关节离断术，其中3例患者因已有转移性疾病而进行了姑息性截肢。所有患者在适当的时候均接受了辅助治疗。
截肢后患者的1年总生存率为56%，2年为39%，5年为27%，10年为21%。作为初次手术进行截肢的患者5年生存率为32%，局部复发患者为25%，而姑息性截肢患者为零。截肢后10例患者出现局部复发，且与切除边缘过近有关；所有这些患者随后均死亡。总体功能较差，只有1例存活患者经常使用假肢。
髋关节离断术仍然是一种致残性手术，通常用于治疗大腿部骨骼和软组织广泛受累的高级别肉瘤。如果能够实现广泛的切除边缘，则有可能实现长期生存。
