保肢治疗与截肢治疗对胫骨远端骨肉瘤患者的生存情况相似，但保肢治疗可改善患者的功能。
Similar survival but better function for patients after limb salvage versus amputation for distal tibia osteosarcoma.
机构信息
Department of Orthopaedics, Orthopaedic Oncology Service, Istituto Ortopedico Rizzoli, University of Bologna, Via Di Barbiano 1/10, 40136, Bologna, Italy.
出版信息
Clin Orthop Relat Res. 2012 Jun;470(6):1735-48. doi: 10.1007/s11999-011-2238-7. Epub 2012 Jan 24.
BACKGROUND
Amputation has been the standard surgical treatment for distal tibia osteosarcoma. Advances in surgery and chemotherapy have made limb salvage possible. However, it is unclear whether limb salvage offers any improvement in function without compromising survival.
QUESTIONS/PURPOSES: We therefore compared the survival, local recurrence, function, and complications of patients with distal tibia osteosarcoma treated with limb salvage or amputation.
METHODS
We retrospectively reviewed 42 patients with distal tibia osteosarcoma treated from 1985 to 2010. Nineteen patients had amputations and 23 had limb salvage and allograft reconstructions. We graded the histology using Broders classification, and staged patients using the Musculoskeletal Tumor Society (MSTS) and American Joint Committee on Cancer (AJCC) systems. The tumor grades tended to be higher in the group of patients who had amputations. We determined survival, local recurrence, MSTS function, and complications. The minimum followup was 8 months (median, 60 months; range, 8-288 months).
RESULTS
The survival of patients who had limb salvage was similar to that of patients who had amputations: 84% at 120 and 240 months versus 74%, respectively. The incidence of local recurrence was similar: three of 23 patients who had limb salvage versus no patients who had amputations. The mean MSTS functional score tended to be higher in patients who had limb salvage compared with those who had amputations: 76% (range, 30%-93%) versus 71% (range, 50%-87%), respectively. The incidence of complications was similar.
CONCLUSION
Patients treated with either limb salvage or amputation experience similar survival, local recurrence, and complications, but better function is achievable for patients treated with limb salvage versus amputation. Local recurrence and complications are more common in patients with limb salvage.
LEVEL OF EVIDENCE
Level III, retrospective comparative study. See the Guidelines for Authors for a complete description of levels of evidence.
背景
截肢一直是治疗胫骨远端骨肉瘤的标准手术方法。随着手术和化疗的进步，保肢治疗成为可能。然而，保肢治疗是否在不影响生存率的情况下能改善功能，目前尚不清楚。
问题/目的：因此，我们比较了接受保肢或截肢治疗的胫骨远端骨肉瘤患者的生存、局部复发、功能和并发症。
方法
我们回顾性分析了 1985 年至 2010 年期间治疗的 42 例胫骨远端骨肉瘤患者。19 例行截肢术，23 例行保肢和同种异体骨重建术。我们采用 Broders 分级系统对组织学进行分级，采用肌肉骨骼肿瘤学会（MSTS）和美国癌症联合委员会（AJCC）系统对患者进行分期。接受截肢的患者肿瘤分级往往更高。我们评估了生存率、局部复发、MSTS 功能和并发症。随访时间至少为 8 个月（中位数 60 个月；范围 8-288 个月）。
结果
保肢患者的生存率与截肢患者相似：120 和 240 个月时分别为 84%和 74%。局部复发率相似：23 例保肢患者中有 3 例，而截肢患者中无局部复发。与截肢患者相比，保肢患者的平均 MSTS 功能评分较高：分别为 76%（范围 30%-93%）和 71%（范围 50%-87%）。并发症发生率相似。
结论
接受保肢或截肢治疗的患者具有相似的生存率、局部复发率和并发症，但保肢治疗患者的功能更好。保肢治疗患者局部复发和并发症更为常见。
证据水平
III 级，回顾性比较研究。完整的证据水平描述请参见作者指南。
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