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目的对成骨肉瘤患者实施新辅助化疗加保肢治疗后进行随访分析。方法121例经病理诊断为成骨肉瘤患者,根据Enneking分级实施新辅助化疗,化疗药物为氨甲喋磷、顺铂、阿霉素和异环磷酰胺,部分IIB期的患者术前实施肿瘤血管栓塞.术后根据肿瘤坏死率选择化疗药物进行进一步化疗。手术方法主要为大段同种骨与关节移植47例,人工肿瘤型假体置换52例。随访采用MSTS保肢评分系统对保肢者进行功能评分。结果121例患者随访16～101个月,生存76例,总生存率62.8%。大段同种移植骨与关节移植47例,术后3～24个月完成骨愈合,MSTS得分(22.60±4.13)分,优良率76.3%。肿瘤型假体置换52例患者,MSTS得分(24.32±3.85)分,优良率84.6%。结论新辅助化疗加保肢手术是目前临床治疗成骨肉瘤较为有效的方法。
Objective To evaluate the follow-up of neoadjuvant chemotherapy and limb salvage therapy in patients with osteosarcoma. Methods A total of 121 patients with osteosarcoma were pathologically diagnosed. According to Enneking classification, neoadjuvant chemotherapy was performed. Metformin, cisplatin, doxorubicin, and ifosfamide were administered to chemotherapy. Part IIB patients underwent preoperative tumor angioplasty Embolization.According to the tumor necrosis rate of chemotherapy drugs for further chemotherapy. The main surgical methods were large bone allograft and joint transplantation in 47 cases, artificial tumor prosthesis replacement in 52 cases. Follow-up MSTS limb salvage scoring system for limb salvage function score. Results 121 patients were followed up for 16 to 101 months, 76 patients survived, the overall survival rate was 62.8%. Forty-seven patients received bone allograft and joint transplantation. The bone healing rate was achieved between 3 and 24 months after operation. The MSTS score was 22.60 ± 4.13 and the excellent and good rate was 76.3%. Tumor type prosthesis replacement in 52 patients, MSTS score (24.32 ± 3.85) points, excellent and good rate of 84.6%. Conclusion Neoadjuvant chemotherapy plus limb salvage surgery is the most effective method for the treatment of osteosarcoma.