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目的 评价保肢术结合辅助化疗治疗肢体Ⅱ B期骨肉瘤的临床疗效。方法 选择 1989年 6月～ 1996年 6月保肢手术结合辅助化疗治疗肢体Ⅱ B期骨肉瘤患者 35例，男 25例，女 10例；年龄 15～ 36岁，平均 20.34岁。发病部位 :股骨下端 22例，胫骨上端 7例，肱骨上端 3例，腓骨上端 2例和股骨上端 1例。 35例中达到广泛切除 20例，而仅达边缘切除 15例。 3例肱骨上端病例行 Tikhoff－ Linberg手术； 2例腓骨上端病例仅做肿瘤切除术；其余 30例病例分别采用瘤骨灭活再植 17例，异体半关节移植 9例和人工假体置换 4例。 31例接受过术前化疗的病例切除标本均做多病理切片的坏死率评估，所有病例接受 3～ 10年 (平均 5年 8个月 )的随访。结果 35例患者 3年无瘤生存 24例 (68.6％ )；无瘤生存超过 5年共有 13例 (生存可能率为 60.4％ )。 31例接受过术前化疗病例的肿瘤细胞坏死率大于 90％者 28例 (90.3％ )。发生并发症 14例 (40.0％ )，其中感染 3例 (8.6％ )，植入骨骨折 7例 (20.0％ )，骨不愈合 1例 (2.9％ )，肿瘤局部复发 3例（ 8.6％）。因并发症而行再次手术共 15例次（ 43.0％），其中截肢 6例 (17.0％ )。肢体功能评估优良率为 68.6％。统计学处理显示肿瘤坏死率与无瘤生存率之间无显著相关性 (rs=0.090?
Objective To evaluate the clinical efficacy of limb salvage surgery combined with adjuvant chemotherapy in the treatment of limb type II B osteosarcoma. Methods From June 1989 to June 1996, limb salvage surgery combined with adjuvant chemotherapy was used to treat 35 cases of limb II B osteosarcoma, 25 males and 10 females; aged 15-36 years, with an average of 20.34 years. Incidence sites: 22 cases in the lower femur, 7 in the upper tibia, 3 in the upper tibia, 2 in the upper tibia, and 1 in the upper femur. In 35 cases, 20 cases were widely resected, and only 15 cases were marginal resection. Three cases of tibial upper extremity underwent Tikhoff-Linberg operation; 2 cases of upper tibial resection only performed tumor resection; 17 cases underwent inactivation of tumor bone in the remaining 30 cases, 9 cases underwent hemiarthroplasty and 4 cases underwent artificial prosthesis replacement. . Thirty-one patients who underwent preoperative chemotherapy were evaluated for necrosis rate in multiple pathological sections. All cases were followed up for 3 to 10 years (average 5 years and 8 months). Results Thirty-five patients had no tumor survival for 24 years (68.6%); 13 patients had no tumor survival for more than 5 years (the survival rate was 60.4%). Thirty-one patients (90.3%) had tumor cell necrosis rate of more than 90% before surgery. Complications occurred in 14 cases (40.0%), including 3 cases (8.6%), 7 cases (20.0%) of bone fractures, 1 case (2.9%) of bone nonunion, and 3 cases of local tumor recurrence (8.6%). A total of 15 reoperations (43.0%) were performed due to complications, including amputation in 6 cases (17.0%). The excellent and good rate of physical function assessment was 68.6%. Statistical analysis showed no significant correlation between tumor necrosis rate and disease-free survival (rs=0.090?