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目的报告表面骨肉瘤的两种少见亚型，即骨膜骨肉瘤和高度恶性表面骨肉瘤的诊治经验。方法回顾 5例骨膜骨肉瘤和 4例高度恶性表面骨肉瘤患者的影像学和病理学特点，并对临床治疗结果进行分析。 5例骨膜骨肉瘤患者，男 1例，女 4例；年龄 28～ 42岁，平均 35岁；肿瘤位于胫骨上段者 4例，股骨下段者 1例。 4例高度恶性表面骨肉瘤患者，男 3例，女 1例；年龄 17～ 23岁，平均 19.25岁； 4例患者肿瘤均位于股骨下段。结果 5例骨膜骨肉瘤均予以广泛切除，除 1例因局部复发行截肢术，现无瘤生存 1年 3个月外，余 4例已无瘤生存 3～ 9年，平均 5年 9个月。 4例高度恶性表面骨肉瘤患者，虽经积极综合治疗，但仅 1例无瘤生存 7年； 1例术后 2年 5个月复发而截肢，现无瘤生存 1年 9个月； 1例于术后 2年 4个月死于肺转移；另 1例在确诊后 3个月死亡。结论骨膜骨肉瘤和高度恶性表面骨肉瘤各具鲜明的影像学和病理学特点，骨膜骨肉瘤恶性程度较低，应采用以局部广泛切除为主的手术治疗，预后相对较好；而高度恶性表面骨肉瘤的生物学行为则与经典的髓内骨肉瘤相似，预后较差，必须采用手术与化疗相结合的综合治疗方法。
Objective To report on two rare subtypes of surface osteosarcoma, namely the diagnosis and treatment of periosteal osteosarcoma and highly malignant surface osteosarcoma. Methods The imaging and pathological features of 5 cases of periosteal osteosarcoma and 4 cases of high-grade surface osteosarcoma were reviewed, and the results of clinical treatment were analyzed. In 5 patients with periosteal osteosarcoma, there were 1 male and 4 females, ranging from 28 to 42 years of age with an average age of 35 years. The tumors were located in the upper segment of the humerus in 4 cases and the lower femur in 1 case. In 4 patients with high-grade surface osteosarcoma, there were 3 males and 1 female; aged 17-23 years with an average of 19.25 years; 4 patients were located in the lower part of the femur. Results All 5 cases of periosteum osteosarcoma were extensively resected. Except 1 case due to partial amputation amputation, and 1 year and 3 months of tumor-free survival, the remaining 4 cases had no tumor survival for 3 to 9 years, with an average of 5 years and 9 months. . In 4 patients with highly malignant surface osteosarcoma, only one patient survived for 7 years despite active comprehensive treatment; 1 patient had relapsed and amputated at 2 years and 5 months postoperatively, and there was no tumor survival for 1 year and 9 months; 1 patient He died of lung metastasis 2 years and 4 months after operation; another patient died 3 months after diagnosis. Conclusion Periosteal osteosarcoma and highly malignant surface osteosarcoma have distinct imaging and pathological features. The degree of malignancy of periosteal osteosarcoma is relatively low. Surgical treatment based on extensive local resection should be used with relatively good prognosis. Highly malignant surface The biological behavior of osteosarcoma is similar to that of classical intramedullary osteosarcoma and its prognosis is poor. Therefore, a combination of surgery and chemotherapy must be used.