Eckardt J J, Eilber F R, Rosen G, Mirra J M, Dorey F J, Ward W G, Kabo J M
Department of Surgery, UCLA Center for the Health Services.
Clin Orthop Relat Res. 1991 Sep(270):202-13.
Over an eight-year period, 100 patients with IIB osteosarcoma have been managed. Eighty-one were treated with limb-salvage procedures, 78 of which involved reconstruction utilizing endoprostheses. Only 19 patients received amputation as the primary treatment for local control. Since 1984, all patients received preoperative and post-operative adjuvant chemotherapy. Those patients who received chemotherapy had a statistically significant improvement in five-year survival over those who did not (57% and 32%, respectively, p = 0.014). The functional results were good overall, with excellent results seen in distal femoral reconstruction. Twenty-eight of the 78 patients treated with endoprosthetic reconstruction experienced 30 complications (36%). Mechanical failure was the most common complication (10%) but was generally correctable. The local recurrence rate was 5% and the infection rate was 3%. Local complications were manageable. A statistical analysis revealed that the relative risk of patient death was 2.5 times higher than prosthesis failure for the 78 patients with endoprosthetic reconstruction. The intermediate-term results, with a median follow-up period of 43 months, remains encouraging.
在八年的时间里，共治疗了100例IIB期骨肉瘤患者。81例行保肢手术，其中78例采用内置假体进行重建。仅19例患者接受截肢作为局部控制的主要治疗方法。自1984年以来，所有患者均接受术前和术后辅助化疗。接受化疗的患者五年生存率较未接受化疗的患者有统计学显著提高（分别为57%和32%，p = 0.014）。总体功能结果良好，股骨远端重建效果极佳。78例接受内置假体重建的患者中有28例出现30种并发症（36%）。机械故障是最常见的并发症（10%），但通常可以纠正。局部复发率为5%，感染率为3%。局部并发症可控。一项统计分析显示，78例接受内置假体重建的患者死亡的相对风险比假体故障高2.5倍。中期结果（中位随访期为43个月）仍然令人鼓舞。
