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目的 对肢体原发成骨肉瘤综合治疗及非综合治疗的结果进行比较和评估。 方法 术前无远处转移的肢体成骨肉瘤患者 170例 ,年龄 6～ 5 2岁 ,平均年龄 2 1岁 ,男性 112例 ,女性 5 8例 ;肿瘤部位 :股骨远端 80例 ,胫骨近端 5 1例 ,股骨近端 7例 ,肱骨近端 10例 ,四肢其它部位 2 2例。施行术前化疗 手术切除肿瘤 术后化疗综合治疗 (综合治疗组 ) 10 4例 ,单纯手术切除肿瘤 (非综合治疗组 )6 6例 ;行保留肢体手术 94例 ,其中施行化疗者 71例 ,未行化疗者 2 3例 ;行截肢术 76例 ,其中行化疗者 33例 ,未行化疗者 43例。 结果 5年生存率 :综合治疗组为 6 1% ,非综合治疗组为 2 8% ;10年生存率 :综合治疗组为 5 3% ,非综合治疗组为 2 6 % ;局部复发率 :综合治疗保肢组为 2 0 % ,截肢组为 3% ;非综合治疗保肢组为 44 % ,截肢组为 7% ;综合治疗组和非综合治疗组肺转移的发生率无明显差异。80例患者按照MSTS评分系统进行功能评定 ,其中保肢组 (5 6例 )平均分值为 71% ,截肢组 (2 4例 )平均分值为 5 3%。 结论 综合治疗可以提高骨肉瘤的存活率 ;肿瘤局部切除及重建手术可以为患者提供比较满意的肢体功能。
Objective To compare and evaluate the results of comprehensive and non-comprehensive treatment of primary osteosarcoma of the limb. Methods 170 cases of limb osteosarcoma with no distant metastasis before operation, aged 6 to 52 years, mean age 21 years, 112 males and 58 females; tumor site: distal femur 80 cases, proximal humerus In 51 patients, there were 7 proximal femurs, 10 proximal tibias, and 22 other limbs. Preoperative chemotherapy was performed after surgical resection of tumors. Postoperative chemotherapy (comprehensive treatment group) 104 cases. Surgical resection of tumors (non-comprehensive treatment group) 66 cases. 94 cases of preserved limb surgery, of which 71 cases performed chemotherapy, not Twenty-three patients were treated with chemotherapy and 76 patients underwent amputation. Among them, 33 received chemotherapy and 43 received no chemotherapy. Results The 5-year survival rate was 6 1% in the comprehensive treatment group and 2 8% in the non-comprehensive treatment group; the 10-year survival rate was 5.3% in the comprehensive treatment group and 26% in the non-comprehensive treatment group; local recurrence rate: comprehensive Treatment of limb salvage group was 20%, amputation group was 3%; non-comprehensive treatment limb salvage group was 44%, and amputation group was 7%; there was no significant difference in the incidence of lung metastasis between the comprehensive treatment group and non-comprehensive treatment group. 80 patients were assessed according to the MSTS score system, in which the average value of the limb salvage group (56 cases) was 71%, and that of the amputation group (24 cases) was 53%. Conclusion Comprehensive treatment can improve the survival rate of osteosarcoma; local tumor resection and reconstruction surgery can provide patients with more satisfactory limb function.