Enneking W F, Kagan A
Cancer. 1978 Apr;41(4):1526-37. doi: 10.1002/1097-0142(197804)41:4<1526::aid-cncr2820410442>3.0.co;2-x.
Forty-five cases of osteosarcoma were studied for transepiphyseal spread of the lesion because of the current interest in local resection and chemotherapy as treatment of this disease. In 17 cases, the epiphyseal plate had closed and all 17 had transepiphyseal extension of the tumor. In 28 cases, the epiphyseal plate was open; 21 showed growth or microscopic evidence of transepiphyseal extension of the lesion. The most common method of extension was directly through the epiphyseal plate along vascular channels, or less commonly, about the epiphyseal plate beneath the perichondrium and into the epiphysis along the epiphyeal vascular channels. The majority of these extensions were not detectable by either conventional radiography or radioisotope scanning. Local resection with preservation of the epiphysis will, in all likelihood, leave residual disease despite the oft-quoted statement that an open epiphyseal plate is a biologic barrier to the extension of bone tumors.
由于目前对骨肉瘤采用局部切除和化疗作为治疗方法的关注，对45例骨肉瘤病例进行了病变经骨骺扩散的研究。在17例中，骨骺板已闭合，所有17例肿瘤均有经骨骺扩展。在28例中，骨骺板开放；21例显示病变有经骨骺扩展的生长或微观证据。最常见的扩展方式是直接通过骨骺板沿血管通道，或较少见的是在骨骺板周围的软骨膜下，沿骨骺血管通道进入骨骺。这些扩展中的大多数通过传统放射摄影或放射性同位素扫描都无法检测到。尽管经常有人说开放的骨骺板是骨肿瘤扩展的生物屏障，但保留骨骺的局部切除很可能会留下残留疾病。
