Funovics P T, Dominkus M, Kotz R
Universitätsklinik für Orthopädie, Medizinische Universität Wien, Währinger Gürtel 18-20, Vienna, Austria.
Handchir Mikrochir Plast Chir. 2008 Feb;40(1):13-8. doi: 10.1055/s-2007-989418.
Malignant lesions of the bones and soft tissues require radical or wide resection to achieve adequate therapy. Due to the many developments in terms of adjuvant modalities, diagnostics and surgical expertise today there are several modes of therapy as alternatives to amputation in the treatment of malignant tumours of the shoulder and upper arm. After resection of smaller tumours excellent functional results can be obtained by the use of modular endoprostheses, whereas large neoplasms adjacent to the neurovascular bundle require resection-replantation to allow salvage of the hand. Within the Vienna Bone Tumour Registry, 100 patients out of a total of more than 6500 have been treated for such lesions: 62 received an endoprostheses, 18 resection-replantation and 20 amputation. In cases of primary malignant tumours the incidence of lung metastases was higher in the resection-replantation group (50 %) and amputation group (42 %) than in the prostheses group (11 %), which has been linked to larger tumour size in the former two groups. Radical or wide resections were obtained in 95 % of the prostheses group, as compared to 75 % and 78 % in the amputation group and the resection-replantation group, respectively, due to invasion into the neurovascular bundle. Over time the number of amputations decreased simultaneously with the increase of endoprostheses whereas the number of resection-replantations remained equal at our institution. Amputation today still plays a crucial role in the treatment of intralesionally resected tumours, as surgical contamination can make limb salvage impossible. Therefore, the importance of biopsy in the therapeutical algorithm of bone and soft tissue tumours has to be emphasised again.
骨骼和软组织的恶性病变需要进行根治性或广泛切除以实现充分治疗。由于在辅助治疗方式、诊断和外科专业技术方面的诸多进展，如今在肩部和上臂恶性肿瘤的治疗中有几种治疗模式可替代截肢。切除较小肿瘤后，使用模块化内置假体可获得优异的功能结果，而紧邻神经血管束的大肿瘤则需要进行切除再植以挽救手部。在维也纳骨肿瘤登记处，超过6500名患者中有100名接受了此类病变的治疗：62例接受了内置假体，18例进行了切除再植，20例进行了截肢。在原发性恶性肿瘤病例中，切除再植组（50%）和截肢组（42%）的肺转移发生率高于假体组（11%），这与前两组肿瘤体积较大有关。假体组95%的患者实现了根治性或广泛切除，相比之下，截肢组和切除再植组分别为75%和78%，原因是肿瘤侵犯神经血管束。随着时间的推移，截肢数量随着内置假体数量的增加而减少，而在我们机构，切除再植的数量保持不变。如今，截肢在瘤内切除肿瘤的治疗中仍起着关键作用，因为手术污染可能使保肢无法实现。因此，必须再次强调活检在骨和软组织肿瘤治疗算法中的重要性。
