Yan Tai-qiang, Guo Wei, Yang Rong-li, Sun Xin, Qu Hua-yi
Orthopaedic Oncology Department, People's Hospital, Peking University, Beijing 100044, China.
Zhonghua Wai Ke Za Zhi. 2010 Oct 15;48(20):1550-5.
To analyze the oncological and functional outcome of limb salvage in this location.
From November 2003 to January 2010, 20 patients with primary malignant bone tumors of the distal lower extremity were treated. There were 15 male and 5 female, the mean age was 20 years. Among 14 patients with malignant distal tibial sarcoma, 11 patients had ankle arthrodesis reconstructed by using allograft (7 patients) or autografts (4 patients), the other 3 patients underwent below-knee amputation. Three patients with osteosarcoma of distal fibula reconstructed with ipsilateral fibular head, 3 patients with calcaneus osteosarcoma underwent total calcanectomy and reconstructed with fibular segment and iliac crest. The mean follow-up was 36.4 months.
Five of 7 (71.4%) patients with allograft reconstruction were associated with delayed wound healing, however, only 1 of 10 patients with autograft had this problem (P = 0.036). One local recurrence was observed, 2 osteosarcoma patients died of disseminated disease. The estimated 2-year and 5-year overall survival for the patients with malignant tibial sarcomas were 92.9% and 79.6% respectively, for the patients with distal tibial high-grade osteosarcoma were 87.5% and 70.0% respectively. The mean functional MSTS score was 82% for limb salvage patients.
The survival of patients with primary malignant bone tumor of distal lower extremity seems to be better than that of other sites. Limb salvage can provide satisfactory local control and functional results.
分析该部位保肢治疗的肿瘤学及功能结局。
2003年11月至2010年1月，对20例下肢远端原发性恶性骨肿瘤患者进行了治疗。其中男性15例，女性5例，平均年龄20岁。14例胫骨远端恶性肉瘤患者中，11例采用同种异体骨（7例）或自体骨（4例）重建踝关节融合，另外3例行膝下截肢。3例腓骨远端骨肉瘤患者采用同侧腓骨头重建，3例跟骨骨肉瘤患者行全跟骨切除，并用腓骨段和髂嵴重建。平均随访36.4个月。
7例同种异体骨重建患者中有5例（71.4%）出现伤口愈合延迟，而10例自体骨患者中只有1例出现此问题（P = 0.036）。观察到1例局部复发，2例骨肉瘤患者死于播散性疾病。胫骨恶性肉瘤患者的2年和5年总生存率估计分别为92.9%和79.6%，胫骨远端高级别骨肉瘤患者分别为87.5%和70.0%。保肢患者的平均功能MSTS评分为82%。
下肢远端原发性恶性骨肿瘤患者的生存率似乎优于其他部位。保肢可提供满意的局部控制和功能结果。
