惡性或侵襲性骨腫瘤之肢體保留手術

Limb Salvage Surgery for Aggressive and Malignant Bone Tumors

施麗媛(Lih-Yuann Shih) ； 陳天雄(Tain-Hsiung Chen) ； 羅惠熙(Wai-Hee Lo)

《Journal of Orthopaedic Surgery Taiwan》 10卷1期 (1993/03) Pp. 95-101

摘要

從1983年到1991年間，共有七十七位病人在台北榮總因骨腫瘤而接受肢體保留手術。對這些病人的選擇是惡性或侵襲性骨腫瘤，在傳統治療上需接受截肢手術，而且沒有下列不適應症者，則考慮給予肢體保留手術。這些不適應症包括：一、重要神經血管受侵犯，二、移位性病理性骨折，三、不適當的切片傷口，四、感染及五、極端年輕的孩子。大部分病人都可以寬範圍切除，重建的方法則視部位而定，共有六十例接受可動關節重建，十七位接受關節固定手術。在最近的追蹤中，有十四位病人已死亡，七位病人有腫瘤轉移，但仍存活，五十六位病人沒有腫瘤的跡象。總共的功能評估有十一位為優，四十五位為良，九位尚可，十二位病人其功能評估為差。二十三位病人共有二十七個併發症，而其中以感染最嚴重。
肢體保留手術是個可行的方法，提供病人較好的功能，但卻不會危害病人的存活，使股腫瘤病人免於截肢的痛苦。對於不同重建方法及材料之選擇，需視病人需要、醫院設備及醫師的經驗而定，如此才能提供病人最滿意的結果。

關鍵字

關節融合重建 ； 可動關節重建 ； 自體骨移植 ； 異體骨移植 ； 訂做人工關節

並列摘要

Form 1983 to 1991, 77 patients have received limb salvage surgery for aggressive or malignant bone tumor of the limbs or pelvis. Wide margin resection can be achieved in most of the patients. Reconstruction was performed with a mobile joint reconstruction in 60 patients and a resection arthrodesis in 17 patients. At follow up, 14 patients died of disease, seven patients survived with disease and 56 patients survived without disease. Local recurrences were encountered in 4 patients (5%) and were treated with amputation. The overall functional results were classified as excellent in 11 patients, good in 45 patients and fair in nine patients. Twelve patients had poor results because of failure of reconstruction due to infection. Twenty-three patients had 27 complications. Among which, infection is the most disastrous. Careful selection of patients and consideration of procedure chosen to reconstruct the defect are important for a successful outcome. The followings were considered as contraindications to resection: major neurovascular involvement, displaced pathological fracture, in-appropriate biopsy, infection and extreme young age. Although various procedures promise functional restoration, the reconstructive procedure should be individualized and designed to meet the needs of the patient.