软骨肉瘤切除后对骨重建方式和材料的选择

背景：软骨肉瘤的预后与肿瘤的部位、大小、切除方式及肿瘤的生物学特性等因素密切相关。目的：通过对软骨肉瘤不同切除方式的回顾性分析，探讨软骨肉瘤性病变骨缺损的重建材料的选择。方法：回顾性分析1999年1月至2010年1月解放军第二军医大学附属长征医院骨科采用切除治疗的82例软骨肉瘤患者的资料，所有患者治疗后经病理证实均为软骨肉瘤。其中男51例，女31例；年龄15-68岁，平均年龄39.8岁。发生于骨盆26例，脊柱19例，股骨19例，胫腓骨8例，肩部（包括肱骨）12例。治疗前均摄X射线片、磁共振成像或CT，并进行ECT检查，对软骨肉瘤的患者临床资料、切除方式和随访结果进行多因素分析，筛选可能的软骨肉瘤预后影响因素。结果与结论：对于软骨肉瘤，不同的切除方式，切除后的复发率、转移率及死亡率差异较大。初次切除采用界限外切除，可以明显降低其复发率、转移率及死亡率。自体骨、异体骨、人工假体都是有效的重建材料，对于功能重建由于使用的材料和方法不同而有所不同，自体骨移植因其来源有限及供体部位并发症受到限制，异体骨移植和人工假体是重建骨缺损的有效方法，现有软骨肉瘤切除后修复重建中，限于为数不多的临床病例报道尚难断定不同重建材料的优劣，是否需要重建，取决于缺损的位置及大小，重建方式决定于切除类型，尽可能兼顾缺损区域外形和功能的修复和重建，软骨肉瘤类型和患者的要求是选择重建材料的重要标准。

Choice of bone reconstruction methods and materials after chondrosarcoma resection

BACKGROUND：The prognosis of chondrosarcoma is closely associated with tumor location, size, removal methods and biological characteristics. OBJECTIVE：To explore the choice of reconstruction materials for bone defects after chondrosarcoma resection based on the retrospective analysis of different resection methods. METHODS：We retrospectively analyzed clinical data from 82 cases of chondrosarcoma who had received hondrosarcoma resection at the Department of Orthopedics, Changzhen Hospital of Second Military Medical University from January 1999 to January 2010. Al the involved patients were confirmed pathological y as having chondrosarcoma, including 51 males and 31 females, with a mean age of 39.8 years （range, 15-68 years）. Chondrosarcoma was found in the pelvis （n=26）, spine （n=19）, femur （n=19）, tibia and fibula （n=8）, and shoulder （including the humerus） （n=12）. Preoperative X-ray, MRI or CT was taken as wel as ECT. Clinical data, resection methods, and fol ow-up results were col ected for multivariate analysis to screen the possible prognostic factors of chondrosarcoma. RESULTS AND CONCLUSION：For chondrosarcoma, different types of resection result in a quite difference in recurrence rates, metastasis and mortality rates. The initial resection which is done outside the boundaries can significantly reduce the recurrence rate, metastasis rate and mortality. Autogenous bone, al ograft bone, and prosthetic reconstruction materials are effective for functional reconstruction. Autologous bone graft is limited clinical y because of its limited sources and complications at donor site. Al ograft or prosthetic reconstruction of bone defects is an effective method. Limited number of clinical cases reported makes it difficult to determine the pros and cons of different reconstruction materials. The need for reconstruction depends on the defect site and size, and reconstruction method depends on the type of resection. The important criteria for the choice of reconstruction materials include both form and functional repair of bone defects, chondrosarcoma type and the patient’s request.