论文部分内容阅读
目的正确认识肢体肿瘤所致病理性骨折的概念和病因，掌握早期诊断与鉴别诊断方法，减少误诊、误治，提高治疗效果。方法１９８１年门月～１９９７年１０月共收治肢体肿瘤所致病理性骨折患者１６２例，其中良性肿瘤与肿瘤样病损８５例，恶性肿瘤７７例。治疗原则：良性肿瘤行刮除植骨，根据不同情况分别采用张力带钢丝、钢板螺钉、石膏以及单臂外固定架进行固定。恶性肿瘤要在配合化疗和放疗基础上分别采用肿瘤段切除灭活再植、开创放疗、异体半关节移植，对于无保肢条件者实行截肢。结果１６２例病理性骨折经过上述治疗均能愈合。以良性骨肿瘤与肿瘤样病损作为原发病的８５例术后１０个月内复发４例；１０～１２个月复发２１例；１～５年复发１２例。恶性骨肿瘤７７例的两年生存率为７８％，五年生存率为４２％。结论肢体肿瘤所致病理性骨折的治疗并不困难，关键是原发病的早期诊断与鉴别诊断。诊断时要认真询问病史和受伤机制，骨折前有夜间痛、轻度外伤就出现骨折要想到肢体肿瘤所致病理性骨折的可能。
Objective To correctly understand the concept and causes of pathological fractures caused by limb tumors, master early diagnosis and differential diagnosis methods, reduce misdiagnosis and mistreatment, and improve treatment effects. METHODS: From 1981 to October 1997, 162 patients with pathological fractures due to limb tumors were treated, of which 85 were benign and tumor-like lesions, and 77 were malignant. Therapeutic principle: Benign tumors are scraped and bone grafted, and tension band steel wire, steel plate screw, plaster and single arm external fixator are used for fixation according to different situations. Malignant tumors should be inactivated with tumor segment resection, open radiotherapy, and allograft hemiarticular transplantation on the basis of chemotherapy and radiotherapy, and amputation should be performed for those without limb salvage. Results All the 162 cases of pathological fractures healed after the above treatments. With benign bone tumors and tumor-like lesions as the primary disease, 85 patients relapsed within 10 months after operation, 4 patients relapsed within 10 to 12 months, and 12 patients relapsed within 1 to 5 years. The two-year survival rate of 77 cases of malignant bone tumors was 78%, and the five-year survival rate was 42%. Conclusion The treatment of pathological fractures caused by limb tumors is not difficult. The key is early diagnosis and differential diagnosis of primary disease. When the diagnosis is made, the medical history and the injury mechanism must be carefully scrutinized. There must be no nighttime pain before the fracture, and a minor traumatic injury should lead to the possibility of a pathological fracture caused by a limb tumor.