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目的探讨足部骨肿瘤的发病特点,提高足部肿瘤的诊治水平。方法回顾分析2000年3月-2009年4月收治的足踝部骨肿瘤32例,男18例,女14例。平均年龄36岁(13～61岁)。其中Ewing肉瘤2例,恶性纤维组织细胞瘤1例,软骨肉瘤3例,转移瘤1例,骨巨细胞瘤2例,软骨母细胞瘤3例,骨囊肿7例,骨样骨瘤2例,内生软骨瘤6例,骨软骨瘤1例,动脉瘤样骨囊肿4例。骨囊肿治疗方法采取透视下经皮注射生物蛋白胶及激素治疗;骨样骨瘤采用CT引导下经皮穿刺微波热疗术;其他良性肿瘤采用常规刮除植骨术。恶性肿瘤采用联合治疗方法,包括术前化放疗、术中磨钻及蒸馏水浸泡、术后放化疗等。结果 1例恶性纤维组织细胞肉瘤术后10个月复发行小腿截肢术,术后12个月死亡。2例Ewing肉瘤术后因转移死亡。感染1例,伤口换药8个月愈合。因异体骨排斥渗液伤口延迟愈合1例,术后9个月痊愈。余29例随访1-59个月(平均19.3个月),长期无瘤生存。结论随着微创概念的引进及新辅助化疗的不断进展,经皮注射生物蛋白胶和激素、经皮微波热疗术在足部骨肿瘤中的应用已经取得初步成果,创伤小,恢复快;各种物理治疗如磨钻、60°蒸馏水等的术中应用可降低复发率。
Objective To investigate the characteristics of foot bone tumors and improve the diagnosis and treatment of foot tumors. Methods A retrospective analysis of 32 cases of ankle bone tumors treated in March 2000 -2009 in April, 18 males and 14 females. The average age is 36 years old (13 to 61 years old). Including sarcoma in 2 cases, 1 case of malignant fibrous histiocytoma, 3 cases of chondrosarcoma, 1 case of metastatic tumor, 2 cases of giant cell tumor of bone, 3 cases of chondroblastoma, 7 cases of bone cyst, osteoid osteoma in 2 cases, Endogenous chondroma in 6 cases, osteochondroma in 1 case, aneurysmal bone cyst in 4 cases. Treatment of bone cysts under the perspective of percutaneous injection of bio-protein glue and hormone therapy; osteoid osteoma using CT-guided percutaneous microwave thermotherapy; other benign tumors using conventional curettage and bone grafting. Malignant tumors using a combination of treatment methods, including preoperative radiotherapy, intraoperative drilling and distilled water immersion, postoperative radiotherapy and chemotherapy. Results One case of malignant fibrohistiocytosarcoma recanalized leg amputation 10 months after operation and died at 12 months after operation. Two cases of Ewing’s sarcoma died of metastasis after surgery. Infection in 1 case, wound dressing 8 months healing. One case was delayed healing due to allograft exudate wounds and recovered at 9 months after operation. The remaining 29 cases were followed up for 1-59 months (average 19.3 months), long-term disease-free survival. Conclusion With the introduction of minimally invasive concept and the continuous progress of neoadjuvant chemotherapy, the application of percutaneous microwave hyperthermia in the treatment of foot bone tumors has achieved initial results, with less trauma and faster recovery. A variety of physical therapy such as grinding drill, 60 ° distilled water and other intraoperative applications can reduce the recurrence rate.