Limb Salvage Operations for Patients with Malignant Bone Tumors in the Extremities

肢體惡性骨腫瘤病患的肢體保全手術

楊榮森(Rong-Sen Yang)

《慈濟醫學雜誌》 17卷6期 (2005/12) Pp. 389-396

https://doi.org/10.6440/TZUCMJ.200512.0389

摘要

近年來新式輔助性化學治療，現代化影像檢查技術，以及新式手術促使肢體保全手術得以成功，並經由廣泛切除腫瘤及合適的重建手術，使病患獲得功能良好，腫瘤切除乾淨，且無痛的康復肢體。這些經過謹慎選擇的病患，可預期會得到較完整的身體平衡功能，簡化復健過程，且身體意象完整，同時其局部再發和存活率皆未變壞。目前，此種肢體保全手術的適應症已擴充到肢體腫瘤以外的其他非腫瘤病況。經廣泛切除腫瘤後，會造成廣大的骨骼和軟組織缺損，目前有許多重建方式可應用於肢體保全手術，包括切除後關節固定手術，各種骨骼移植手術（帶血管自體骨移植，或一般自體骨移植，異體骨移植，或異體骨移植合併人工關節），Illizarov氏肢體延長術，轉位整型術，以及使用訂製型腫瘤人工關節進行重建等方式。這些方式已帶來預期的成功，但卻各有其優缺點，包括生物方面的或與人工關節相關的併發症。在選用合適的方式時，須個別考量病況，包括影像檢查結果，病理組織檢查，以及臨床病況等。

關鍵字

肢體保全手術 ； 骨移植 ； 組合式腫瘤人工關節 ； 併發症 ； 人工關節重建手術

並列摘要

Neoadjuvant chemotherapy, modem imaging analyses, and developments in surgical techniques in recent decades have enabled limb salvage surgery to provide well-functioning, tumor-free, painless limbs through excision of the tumor with an adequate margin and proper reconstruction. With proper selection, patients are expected to have mostly intact body balance, a simple rehabilitation process, and an intact body image, but not at the expense of local recurrence and survival. Currently the indications of such a limb salvage procedure have been expanded to other non-malignant tumorous conditions in addition to malignant juxta-articular bone tumors in the extremities. Wide resection of a tumor can result in massive bone and soft-tissue defects. Currently, many options for reconstruction with limb salvage procedures are available, including resection arthrodesis, various bone graft techniques (vascularized or conventional autografts, allografts, or allograft/endoprosthesis composites), Ilizarov leg lengthening, rotationplasty, reconstruction with custom-made oncological endoprostheses, etc. These have resulted in expected successes, while simultaneously producing biological or prosthesis-related complications due to their unique advantages and disadvantages. The choice of an option requires careful individual considerations, including imaging radiological staging, pathological staging, and the clinical status.

並列關鍵字

limb salvage operation ； bone graft ； modular oncological endoprosthesis ； complications ； endoprosthetic reconstruction