Huang Junqi, Bi Wenzhi, Han Gang, Jia Jinpeng, Xu Meng, Wang Wei
Department of Orthopaedics, Mianyang Central Hospital, Mianyang, 621000, Sichuan, China.
Department of Orthopaedics, PLA General Hospital, Beijing, 100853, China.
BMC Musculoskelet Disord. 2018 Sep 5;19(1):315. doi: 10.1186/s12891-018-2245-x.
Survival and reconstruction constitute important challenges in multimodal treatment of osteosarcoma of the proximal tibia. The purpose of this study was to assess the efficacy and prognosis of neoadjuvant chemotherapy and custom-designed endoprosthetic arthroplasty.
A total of 69 patients with osteosarcoma of the proximal tibia were evaluated, including 43 males and 26 females, treated with multidisciplinary limb-salvage remedy from October 2003 to December 2013. They were at least 12 years old (mean, 20 years; range, 12-57 years). The gap between tumor and main artery/nerve was showed in MRI. Mean follow up was 69.5 months (range, 9-144 months). Kaplan-Meier survival curves were generated to assess prognosis and relapse rate. The initial symptoms and disease duration for each patient were recorded. Correlation analyses were performed for the association of various parameters with prognosis. Functional outcomes were evaluated using the Musculoskeletal Tumor Society (MSTS) guidelines after 6 months postoperatively, to analyze the relation between bone excision size and function recovery.
The resection lengths measured intraoperatively ranged from 80 to 230 mm, and contained 3 cm of normal bone around the tumor. A total of 3 courses of preoperative chemotherapy were administered to all cases. At final follow-up, 1 case showed recurrence. Meanwhile, 8 patients (11.6%) died from lung metastasis. Post-operative infection occurred in 3 patients; 1 case was maintained with revision surgery. Two cases underwent amputation. The mean MSTS system score was 21.6.
The multidisciplinary treatment result in an overall positive outcome, with improved function.
在胫骨近端骨肉瘤的多模式治疗中，生存和重建是重要挑战。本研究的目的是评估新辅助化疗和定制型人工关节置换术的疗效及预后。
对2003年10月至2013年12月期间接受多学科保肢治疗的69例胫骨近端骨肉瘤患者进行评估，其中男性43例，女性26例。患者年龄至少12岁（平均20岁；范围12 - 57岁）。MRI显示肿瘤与主要动脉/神经之间的间隙。平均随访69.5个月（范围9 - 144个月）。绘制Kaplan - Meier生存曲线以评估预后和复发率。记录每位患者的初始症状和病程。对各种参数与预后的相关性进行分析。术后6个月使用肌肉骨骼肿瘤学会（MSTS）指南评估功能结果，以分析骨切除大小与功能恢复之间的关系。
术中测量的切除长度为80至230毫米，肿瘤周围包含3厘米正常骨。所有病例均接受3个疗程的术前化疗。末次随访时，1例出现复发。同时，8例患者（11.6%）死于肺转移。3例患者发生术后感染；1例通过翻修手术维持。2例行截肢术。MSTS系统平均评分为21.6。
多学科治疗取得了总体积极的结果，功能得到改善。
