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題 名 | Resection Arthrodesis of the Knee for Osteosarcoma: An Alternative When Mobile Joint Reconstruction Is Not Feasible=以切除後關節融合術治療膝關節附近之惡性骨肉瘤 |
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作 者 | 施信農; 施麗媛; | 書刊名 | 長庚醫學 |
卷 期 | 28:6 2005.06[民94.06] |
頁 次 | 頁411-420 |
分類號 | 416.66 |
關鍵詞 | 肢體保留手術; 腫瘤型人工關節重建; 切除後關節融合術; 截肢; 惡性骨肉瘤; Resection arthrodesis; Endoprosthetic reconstruction; Amputation; Osteosarcoma; |
語 文 | 英文(English) |
中文摘要 | 背景: 肢體保留手術加上腫瘤型人工關節重建為目前治療膝關節附近的惡性骨肉瘤中最被廣泛接受的方法。但有一病人卻因特殊的情況,而不得不接受切除後關節融合術或截肢的治療。 方法: 在1991到2000年間,共有86位膝關節附近惡性骨肉瘤的病人在林口長庚醫院接受手術治療。其中有35位病人接受肢體保留手術加上腫瘤型人工關節重建,36位病人接受切除後關節融合術治療,15位病人接受截肢治療。我們比較接受不同方法治療病人的腫瘤預後和肢體功能,尤其著重於探討病人為什麼必須接受關節融合術的原因、關節融合術技術的改進、及這些改進對降低併發症的貢獻。 結果:腫瘤侵犯範圍太大和不適當的先前治療(包括非骨腫瘤醫師治療後再發、不適當的切片位置、切片後血腫及錯誤診斷) 為病人必須接受切除後關節融合術的兩大主因。局部復發率在人工關節重建組為11.4%,在關節融合組為11.1%,在截肢組為6.7%。顯示關節融合組因不必考慮關節功能,可以有較大範圍的切除,反而使得局部復發率沒有預期的高。五年存活率在人工關節組為60%,在關節融合為39%,在截肢組為13%。顯示接受關節融合或截肢的病人通常都太晚接受治療。29%的關節融合組的病人產生併發症,比以其他方法作關節融合的併發症為低,可能原因包括使用局部皮瓣包覆異體骨以降低感染率、在異體骨與自體骨接縫處大量的自體骨移植以增加骨癒合率、及在異體骨上不釘螺絲孔以免降低異體骨的強度等。關節融合病人術後雖然喪失了關節活動,但卻有一個不痛又穩定的肢體,也免去面臨截肢的厄運。 結論: 對惡性骨肉瘤的治療,沒有比早期治療和從組織切片開始專業而有計劃的治療更重要的事了。若惡性骨肉瘤得以早期照正規方法治療,通常可以保留一個功能幾近正常的肢體。若因種種因素,使得腫瘤切除後以人工關節重建的方法無法執行時,關節融合術是個可以考量的方法。切除後關節融合術雖然喪失了關節活動,卻可以保留一個不痛又穩定的肢體,比起截肢又更勝一籌。 |
英文摘要 | Background: Wide resection and mobile joint reconstruction are preferable for treating an osteosarcoma around the knee. In certain situations, resection arthrodesis or an amputation is suggested. Methods: During the past decade, 86 patients with an osteosarcoma around the knee were treated surgically in our institution. Wide resection and endoprosthetic reconstruction were performed in 35 patients, resection arthrodesis was performed in 36 patients, and an amputation was performed in 15 patients. The oncological and functional results were compared. Special attention was paid to the indications, techniques, and complications of patients receiving resection arthrodesis. Results: Extensive tumor involvement was the main reason, followed by inappropriate previous treatment, for precluding mobile joint reconstruction. The local recurrence rates were similar among the 3 groups (11.4% for the endoprosthetic group, 11.1% for the arthrodesis group, and 6.7% for the amputation group). The 5-years survival rate was 39% for the arthrodesis group, which was significantly lower than that of the endoprosthetic group (60%, p=0.040), although it was higher than that of the amputation group (13%,p=0.056). Major complications were found in 7 patients receiving resection arthrodesis (7/24, 29%), and these included nonunion, infection, and allograft fracture. Functional results for the arthrodesis patients were inferior to those of the endoprosthetic patients, but most patients were grateful for preservation of the limb despite certain handicaps. Conclusions: The importance of early and proper planning of treatment cannot be overstressed when treating osteosarcomas. Resection arthrodesis offers a durable reconstruction alternative to amputation in a special group of patients when extensive resection precludes mobile joint reconstruction. |
本系統中英文摘要資訊取自各篇刊載內容。