Soucacos P N, Dailiana Z H, Beris A E, Xenakis T H, Malizos K N, Chrisovitsinos J
Department of Orthopaedic Surgery, University of Ioannina, School of Medicine, Greece.
Bull Hosp Jt Dis. 1996;55(1):46-52.
In the presence of the notable progress in limb-sparing techniques afforded by the developments in microsurgery and musculoskeletal oncology, major ablative surgery of the extremities still remains a last-resort, yet powerful tool in managing patients with primary tumors in whom wide excision is not possible, as well as in cases with severe trauma to the limbs. During the last thirteen years, eight major ablative procedures were performed at the Department of Orthopaedic Surgery of the University of Ioannina Medical School. Seven out of the eight procedures were performed in patients with primary malignant tumors either because the anatomical location or multiple recurrences of the tumor did not allow removal by wide local excision or by amputation at a lower level. In one patient, the procedure was related to a severe, mangling trauma. Four illustrative cases of the eight major ablative procedures performed are reported to highlight the current indications of this rarely used, complex, and extensive surgery. The characteristic cases presented are: hemipelvectomy in a patient with chondrosarcoma of the pelvis, disarticulation of the hip in a patient with a malignant histiocytoma of the supracondylar area of the knee, forequarter amputation in a patient with a basal cell carcinoma of the axilla, and disarticulation of the shoulder in a patient with an incomplete nonviable amputation at the level of the shoulder girdle associated with severe damage to the brachial plexus and axillary artery. After a five to over a ten year follow-up, six of the eight patients who where subjected to major ablative procedures are doing well and are satisfactorily active. These cases reflect the dilemma that orthopaedic surgeons geons still face in selecting limb salvage or major ablative surgery in cases of aggressive malignant tumors to severe trauma.
随着显微外科和肌肉骨骼肿瘤学的发展，保肢技术取得了显著进展，但对于无法进行广泛切除的原发性肿瘤患者以及肢体严重创伤的情况，肢体大切除术仍然是一种最后的手段，但却是一种有力的治疗工具。在过去的十三年里，约阿尼纳大学医学院骨科进行了八例肢体大切除术。其中七例手术是针对原发性恶性肿瘤患者进行的，原因是肿瘤的解剖位置或多次复发不允许通过广泛局部切除或更低水平的截肢来切除。在一名患者中，该手术与严重的肢体毁损性创伤有关。报告了所进行的八例肢体大切除术中的四个典型病例，以突出这种很少使用、复杂且广泛的手术的当前适应症。所呈现的典型病例包括：一名骨盆软骨肉瘤患者的半骨盆切除术、一名膝关节髁上区域恶性组织细胞瘤患者的髋关节离断术、一名腋窝基底细胞癌患者的上肢截肢术，以及一名肩带水平不完全不可存活截肢且伴有臂丛神经和腋动脉严重损伤患者的肩关节离断术。经过五到十多年的随访，接受肢体大切除术的八名患者中有六名情况良好，活动情况令人满意。这些病例反映了骨科医生在面对侵袭性恶性肿瘤至严重创伤病例时，在选择保肢或肢体大切除术方面仍然面临的困境。
