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目的:探讨和比较不同手术术式治疗涉及桡骨远端的骨肉瘤的手术适应症选择,临床疗效和安全性。方法:将2005年-2014年我院收治的涉及到桡骨远端并进行外科手术治疗的骨巨细胞瘤患者共88例进行回顾性分析。根据影像学Campanacci分级,主要手术方法分为以下三种,分别为:A组:微波天线高温原位灭活,自体髂骨,异体骨粒符合骨水泥重建修复术;B:瘤骨切除并腓骨移植术;C:瘤骨刮除灭活并原位植骨术。结合详实的随访资料对两组患者在术后的复发率,腕关节功能(Enneking)等情况给予分析和评价。结果:A组复发率为10.87%,腕关节功能MSTS93功能评分为26.32±2.92分。B组复发率为0,腕关节术后的MSTS93功能评分为22.85±4.16分。C组复发率为30.24%。腕关节术后的MSTS93功能评分为26.97±2.84分。三组相比,A、B与C组在复发率中有明显统计学差异(P<0.05),A组、C组的术后功能评分明显优于B组(P<0.05),但两组之间无统计学差异(P>0.05)。A组中有1例切口表层感染,B组中有2例皮肤感染,均经加强换药后治愈。结论:瘤段切除手术能够有效的降低复发率,但局部功能恢复较差,容易出现切口感染等并发症。微波灭活手术可以有效的杀灭肿瘤组织并保证良好的功能性,但复发率相对较高。在临床工作中应根据患者具体病情和需要给予针对性的手术方案。
Objective: To investigate and compare the surgical indications, clinical effects and safety of different surgical procedures for the treatment of osteosarcoma involving the distal radius. METHODS: A total of 88 patients with giant cell tumor of the giant cell tumor who were treated in our hospital from 2005 to 2014 and involved in the surgical treatment of the distal radius were analyzed retrospectively. According to the imaging Campanacci grading, the main surgical methods are divided into the following three groups, namely: Group A: microwave antenna in situ inactivation at high temperature, autologous iliac bone, allograft bone grafting consistent with bone repair; B: tumor resection and fibula Transplantation; C: Tumescent incision inactivated and bone graft in situ. Combined with detailed follow-up data on the two groups of patients in the recurrence rate, the function of the wrist (Enneking) and so on given the analysis and evaluation. Results: The recurrence rate was 10.87% in group A and 26.32 ± 2.92 in wrist function MSTS93. The recurrence rate of group B was 0, and the MSTS93 function score of wrist was 22.85 ± 4.16. The recurrence rate in group C was 30.24%. MSTS93 function score after wrist surgery was 26.97 ± 2.84 points. The recurrence rates of A, B and C groups were significantly different (P <0.05), and the functional scores of A and C groups were significantly better than those of B group (P <0.05) No significant difference between (P> 0.05). In group A, there was 1 case of incisional wound infection and 2 cases of skin infection in group B, which were cured after intensive dressing change. Conclusion: Tumor resection can effectively reduce the recurrence rate, but the local functional recovery is poor, prone to incision infection and other complications. Microwave inactivation surgery can effectively kill the tumor tissue and ensure good functionality, but the relapse rate is relatively high. In clinical work should be based on the specific patient’s condition and need to give targeted surgical options.