Springfield D S, Enneking W F, Neff J R, Makley J T
Instr Course Lect. 1984;33:1-25.
Primary musculoskeletal tumors are rare in the practice of orthopaedic surgery because they are unusual in the general population. The orthopaedist is often the first physician faced with the decision of how the patient should be evaluated and treated. The best opportunity for control of the tumor and maximal function is dependent on the initial management. History and physical examination are essential. Each patient must be appropriately staged to determine the anatomic extent of the tumor and its histologic type and grade. Plane x-ray examination, tomograms, isotope bone scans, angiograms, and CT are all useful tools in the staging of a musculoskeletal tumor but must be requested with specific questions asked of the radiologist if maximal benefit is to be obtained from them. Serum determination of calcium, phosphorus, alkaline phosphatase, protein electrophoresis, and sedimentation rate and urine determination of protein electrophoresis are the minimal laboratory evaluations suggested. Following careful staging of the patient and discussion with the pathologist regarding possible diagnoses and treatment, a thoughtful biopsy should be done. Consideration should be given to an immediate limb salvage procedure when appropriate, based on a frozen section diagnosis. This requires that the surgeon who performs the biopsy accept the responsibility for the definitive treatment of the patient.
原发性肌肉骨骼肿瘤在骨科手术中较为罕见，因为它们在普通人群中并不常见。骨科医生常常是首位面临如何对患者进行评估和治疗决策的医生。控制肿瘤并实现最大功能的最佳机会取决于初始治疗。病史和体格检查至关重要。每位患者都必须进行适当的分期，以确定肿瘤的解剖范围及其组织学类型和分级。X线平片、断层扫描、同位素骨扫描、血管造影和CT都是肌肉骨骼肿瘤分期的有用工具，但如果要从这些检查中获得最大益处，必须向放射科医生提出具体问题后再进行检查。血清钙、磷、碱性磷酸酶、蛋白电泳和血沉测定以及尿蛋白电泳测定是建议进行的最低限度实验室评估。在对患者进行仔细分期并与病理学家讨论可能的诊断和治疗方案后，应进行谨慎的活检。根据冰冻切片诊断，在适当情况下应考虑立即进行保肢手术。这要求进行活检的外科医生承担对患者进行确定性治疗的责任。
