膝关节周围骨肉瘤假体置换研究

发布时间：2018-05-12 05:21

本文选题：骨肉瘤 + 新辅助化疗　；参考：《中国人民解放军医学院》2017年硕士论文

【摘要】：目的回顾性研究膝关节周围骨肉瘤假体置换术后的长期疗效。方法随访2005年至2013年在解放军总医院确诊并进行新辅助化疗和肿瘤假体置换手术的膝关节周围骨肉瘤患者。通过查阅病历、电话问询、门诊随访等方式分析患者初诊情况、治疗过程以及术后疗效。初诊情况包括首发症状、症状持续时间、影像学检查、是否合并病理性骨折;治疗过程包括新辅助化疗方案与解救、手术切除与重建;术后疗效评估包括骨肉瘤复发转移、膝关节活动功能、假体相关并发症。结果符合纳入标准的患者共255例。其中股骨远端182例,胫骨近端73例。以疼痛症状就诊的患者165例,以肿块表现而就诊患者23例,同时伴有疼痛、肿胀的患者64例,其他因素就诊的患者3例。平均症状持续时间4个月。化疗方案为异环磷酰胺、甲氨蝶呤(顺铂)、多柔比星,坏死率大于90%的患者153例。手术采用普通肿瘤假体置换患者226例,可延长假体置换患者29例。综合治疗后5年生存率为83.1%。假体重建术后平均MSTS功能评分27分。术后发生感染5例,假体周围骨折3例,假体断裂3例,假体脱位1例。结论新辅助化疗对于骨肉瘤全身的控制和远期生存率的保障起到十分重要的作用。假体重建保留肢体和部分功能,提高患者生活质量。
[Abstract]:Objective to study the long-term effect of osteosarcoma around knee arthroplasty. Methods the patients with peri-knee osteosarcoma diagnosed in PLA General Hospital from 2005 to 2013 and underwent neoadjuvant chemotherapy and tumor prosthesis replacement were followed up. By consulting medical records, telephone inquiries, outpatient follow-up and other ways to analyze the first visit, treatment process and postoperative efficacy. The initial diagnosis includes initial symptoms, duration of symptoms, imaging examination, whether associated with pathological fractures; the treatment process includes neoadjuvant chemotherapy regimen and rescue, surgical resection and reconstruction; postoperative evaluation includes recurrence and metastasis of osteosarcoma. Knee motion function, prosthetic related complications. Results 255 patients met the inclusion criteria. There were 182 cases of distal femur and 73 cases of proximal tibia. 165 patients with pain symptoms, 23 patients with mass, 64 patients with pain and swelling, 3 patients with other factors. The mean duration of symptoms was 4 months. The chemotherapy regimen was isocyclophosphamide, methotrexate (cisplatin, doxorubicin), and the necrotic rate was more than 90% in 153 patients. There were 226 patients with conventional tumor prosthesis replacement and 29 patients with prolonged prosthesis replacement. The 5-year survival rate after combined therapy was 83.1%. The average MSTS score after prosthesis reconstruction was 27. Infection occurred in 5 cases, periprosthetic fracture in 3 cases, fracture of prosthesis in 3 cases and dislocation of prosthesis in 1 case. Conclusion Neoadjuvant chemotherapy plays an important role in systemic control and long-term survival of osteosarcoma. Prosthesis reconstruction preserves limbs and some functions to improve the quality of life of patients.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R738

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