Aksnes L H, Bauer H C F, Jebsen N L, Follerås G, Allert C, Haugen G S, Hall K S
Division of Rehabilitation, The Norwegian Radium Hospital, Rikshospitalet University Hospital, Oslo, Norway.
J Bone Joint Surg Br. 2008 Jun;90(6):786-94. doi: 10.1302/0301-620X.90B6.19805.
We evaluated the long-term functional outcome in 118 patients treated for osteosarcoma or Ewing's sarcoma in the extremities a minimum of five years after treatment. We also examined if impaired function influenced their quality of life and ability to work. The function was evaluated according to the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS). Quality of life was assessed by using the Short Form-36 (SF-36). The mean age at follow-up was 31 years (15 to 57) and the mean follow-up was for 13 years (6 to 22). A total of 67 patients (57%) initially had limb-sparing surgery, but four had a secondary amputation. The median MSTS score was 70% (17% to 100%) and the median TESS was 89% (43% to 100%). The amputees had a significantly lower MSTS score than those with limb-sparing surgery (p < 0.001), but there was no difference for the TESS. Tumour localisation above knee level resulted in significantly lower MSTS scores and TESS (p = 0.003 and p = 0.02, respectively). There were no significant differences in quality of life between amputees and those with limb-sparing surgery except in physical functioning. Of the patients 11% (13) did not work or study. In multivariate analysis, amputation, tumour location above the knee and having muscular pain were associated with low physical function. We conclude that most of the bone tumour survivors managed well after adjustment to their physical limitations. A total of 105 are able to work and have an overall good quality of life.
我们评估了118例接受肢体骨肉瘤或尤文肉瘤治疗的患者在治疗后至少五年的长期功能结局。我们还研究了功能受损是否会影响他们的生活质量和工作能力。根据肌肉骨骼肿瘤学会（MSTS）评分和多伦多肢体挽救评分（TESS）对功能进行评估。使用简短健康调查问卷（SF-36）评估生活质量。随访时的平均年龄为31岁（15至57岁），平均随访时间为13年（6至22年）。共有67例患者（57%）最初接受了保肢手术，但有4例进行了二次截肢。MSTS评分中位数为70%（17%至100%），TESS中位数为89%（43%至100%）。截肢患者的MSTS评分明显低于保肢手术患者（p<0.001），但TESS评分无差异。肿瘤位于膝关节以上水平导致MSTS评分和TESS评分明显更低（分别为p = 0.003和p = 0.02）。除身体功能外，截肢患者和保肢手术患者在生活质量方面没有显著差异。11%（13例）的患者无法工作或学习。多变量分析显示，截肢、肿瘤位于膝关节以上以及有肌肉疼痛与身体功能低下有关。我们得出结论，大多数骨肿瘤幸存者在适应身体限制后情况良好。共有105例能够工作，总体生活质量良好。
