Ahlmann Elke R, Menendez Lawrence R, Fedenko Alexander N, Learch Thomas
Department of Orthopaedics, Los Angeles County-University of Southern California Medical Center, Los Angeles, CA, USA.
Clin Orthop Relat Res. 2006 Oct;451:201-7. doi: 10.1097/01.blo.0000229293.98850.5d.
Successfully managing low-grade chondrosarcomas with margins considered less than wide would minimize the need for extensive reconstruction. We report our experience using cryotherapy as an adjuvant to treat patients with low-grade intracompartmental chondrosarcomas. Ten consecutive patients had intralesional resections including curettage, cryo-surgery, and polymethylmethacrylate application. Eight of these patients required prophylactic skeletal stabilization. We retrospectively reviewed the outcomes for tumor recurrence, disease progression, and complications. The Musculo-skeletal Tumor Society rating scale was used to evaluate functional outcome, and the mean score was 27 points (range, 25-30 points). The mean age of the patients was 54.4 years (range, 29-83 years), and the average followup was 38.5 months (range, 24-60 months). Patients were treated for lesions of the femur (n = 3), humerus (n = 3), scapula (n = 2), tibia (n = 1), and acetabulum (n = 1). There was no evidence of recurrence or metastases. At the latest followup, all patients were well, however, one patient had hardware loosening. In this small group of patients, intralesional resection with adjuvant cryoablation provided an alternative to more radical procedures for low-grade intracompartmental chondrosarcoma.
成功处理切缘宽度小于广泛切除标准的低级别软骨肉瘤,将可最大程度减少广泛重建的需求。我们报告了使用冷冻疗法作为辅助手段治疗低级别骨内软骨肉瘤患者的经验。连续10例患者接受了病损内切除,包括刮除、冷冻手术及聚甲基丙烯酸甲酯植入。其中8例患者需要预防性骨骼稳定术。我们回顾性分析了肿瘤复发、疾病进展及并发症的结果。采用肌肉骨骼肿瘤学会评分量表评估功能结果,平均评分为27分(范围为25 - 30分)。患者的平均年龄为54.4岁(范围为29 - 83岁),平均随访时间为38.5个月(范围为24 - 60个月)。患者所治疗的病损部位包括股骨(n = 3)、肱骨(n = 3)、肩胛骨(n = 2)、胫骨(n = 1)和髋臼(n = 1)。无复发或转移证据。在最近一次随访时,所有患者情况良好,不过,有1例患者出现内固定松动。在这一小群患者中,病损内切除联合辅助性冷冻消融术为低级别骨内软骨肉瘤提供了一种替代更激进手术的方法。