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目的探讨膝关节周围骨肉瘤保肢术中MRI的应用及其临床意义。方法43例骨肉瘤患者,均行X线及MRI成像检查,对肿瘤进行外科分期,评价肿瘤在骨髓及周围软组织中的浸润范围,制定手术方案并定制假体,化疗结束后行瘤段切除定制人工假体置换术。术后对标本进行病理组织学检查,与MR成像进行对比分析。随访评估患肢的功能,并定期化疗。结果43例患者,Ⅱa期10例,Ⅱb期33例,均按术前制定方案顺利完成手术,术后平均功能恢复率为76.7%。骨肉瘤MRI上表现缺乏特异性,但在骨髓浸润的显示,肿瘤与肌肉、血管、神经、相邻关节的关系,跳跃病灶的显示及骨肉瘤内出血和坏死的显示,MRI具有无可比拟的优势。结论在骨肉瘤保肢术中MRI的应用具有重要意义,它可以为保肢手术提供丰富的信息,这对合理制定手术方案及保证手术效果有极大的临床价值。
Objective To investigate the clinical application of MRI in the limb salvage surgery of osteosarcoma around the knee joint. Methods Forty-three patients with osteosarcoma were examined by X-ray and MRI. Surgical staging of the tumor was performed to evaluate the extent of tumor infiltration in the bone marrow and surrounding soft tissue. The surgical plans and customized prostheses were made. After the chemotherapy, tumor resection was performed Artificial prosthesis replacement. The specimens were histopathologically examined and compared with MR imaging. Follow-up assessment of limb function, and regular chemotherapy. Results 43 patients, 10 cases of stage Ⅱ a, 33 cases of stage Ⅱ b, according to preoperative plan to successfully complete the operation, the average postoperative functional recovery rate was 76.7%. Osteosarcoma on MRI performance of the lack of specificity, but in the bone marrow infiltration showed that the tumor and muscle, blood vessels, nerves, adjacent joints, skip lesions showed osteosarcoma and hemorrhage and necrosis showed that MRI has unparalleled advantages . Conclusion The application of MRI in limb salvage surgery of osteosarcoma is of great significance. It can provide abundant information for limb salvage surgery, which has great clinical value for the reasonable formulation of surgical procedures and the assurance of surgical results.