Cooney W P, Damron T A, Sim F H, Linscheid R L
Department of Orthopedics, Mayo Clinic and Mayo Foundation, Rochester, Minnesota 55905, USA.
J Bone Joint Surg Am. 1997 Mar;79(3):406-12. doi: 10.2106/00004623-199703000-00014.
The operative treatment of malignant tumors and aggressive benign tumors involving the distal end of the ulna often necessitates en bloc resection. The oncological and functional results for eight patients in whom a neoplasm involving the distal end of the ulna had been treated with en bloc resection without reconstruction of the osseous defect were reviewed retrospectively at a mean of seventy-nine months (range, twenty-three to 271 months). Four patients had a giant-cell tumor; two, a low-grade osteogenic sarcoma; one, a hemangioendothelioma; and one, a soft-tissue epithelioid sarcoma with osseous involvement. The amount of bone that was removed from the distal end of the ulna ranged from 3.1 to 9.0 centimeters. In the four patients who had a malignant tumor, a minimum of 7.5 centimeters was removed in order to achieve an adequate wide margin proximally. In the patients who had a benign tumor, a maximum of 6.6 centimeters was resected. Extraperiosteal resection was performed in three of the patients who had a malignant tumor and in one of the patients who had an aggressive giant-cell tumor. Subperiosteal resection was performed in the three patients who had a benign tumor and in one patient who had a parosteal osteogenic sarcoma. None of the patients had local or systemic evidence of recurrence of the tumor. The functional result was excellent for six patients and good for two. Grip strength was reduced by a mean of 15 per cent compared with the strength on the contralateral side, and this reduction did not appear to be related directly to the amount of bone that had been resected. The findings of this study support the concept that routine reconstruction of the osseous defect is not necessary after en bloc resection of a neoplasm of the distal end of the ulna.
对于累及尺骨远端的恶性肿瘤和侵袭性良性肿瘤，手术治疗通常需要整块切除。我们回顾性研究了8例尺骨远端肿瘤接受整块切除且未重建骨缺损患者的肿瘤学和功能结果，平均随访时间为79个月（范围为23至271个月）。4例患者为骨巨细胞瘤；2例为低级别骨肉瘤；1例为血管内皮瘤；1例为伴有骨受累的软组织上皮样肉瘤。从尺骨远端切除的骨量为3.1至9.0厘米。4例患有恶性肿瘤的患者，近端至少切除7.5厘米以获得足够的安全切缘。患有良性肿瘤的患者，最多切除6.6厘米。3例患有恶性肿瘤的患者和1例患有侵袭性骨巨细胞瘤的患者进行了骨膜外切除。3例患有良性肿瘤的患者和1例骨旁骨肉瘤患者进行了骨膜下切除。所有患者均无肿瘤局部或全身复发的证据。6例患者功能结果优秀，2例良好。与对侧相比，握力平均降低了15%，且这种降低似乎与切除的骨量没有直接关系。本研究结果支持这样的观点，即尺骨远端肿瘤整块切除后，常规重建骨缺损并非必要。
