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目的探索侵犯关节周围骨组织的肢体软组织肉瘤的外科手术方法 ,并分析术后并发症、肢体功能和患者的生存状况。方法回顾性分析2004年5月至2011年10月期间,我中心所收治的30例局部侵犯关节周围骨组织的软组织肉瘤患者的临床资料。其中男14例,女16例,平均年龄51岁(17～75岁)。恶性纤维组织细胞瘤12例,脂肪肉瘤8例,原始神经外胚层肿瘤(PNET)4例,滑膜肉瘤、腺泡状软组织肉瘤和恶性神经鞘瘤2例。其中10例发病位于股骨近端,9例股骨远端,8例肱骨近端,2例胫骨近端,1例累及整个股骨。所有患者均采取了肿瘤连同受累骨组织一起广泛切除、以肿瘤型假体重建骨缺损的手术方式。术后定期复查患肢功能、X线片、肺CT等,并且密切随访,内容包括术后并发症的发生情况、肢体功能恢复情况及肿瘤学与生存状况等。结果平均随访25个月(3-84个月),1例暂时性腓总神经麻痹;3例术后伤口愈合不良行清创手术,其中1例因深部感染不愈而截肢;2例假体断裂行翻修手术;4例肿瘤复发,局部复发率13.3%,其中1例接受截肢手术。总的肺转移为15例,且11例死亡患者中均为肺转移,其中3例合并骨转移。至最后一次随访时14例无瘤生存,5例带瘤生存,平均MSTS评分股骨近端90%,股骨远端82%,胫骨近端73%,肱骨近端71%,全股骨为60%。2年和5年生存率分别为61.6%和30.8%。结论将受累骨组织和肿瘤一起广泛切除可获得无瘤边界,降低复发率,骨缺损采用肿瘤型假体重建可恢复良好的肢体功能。巨大肢体软组织肉瘤侵犯骨组织可能是患者预后不良的因素。
Objective To explore the surgical methods to infiltrate the soft tissues and sarcomas of the limbs around the joint and to analyze the postoperative complications, the function of the limbs and the living conditions of the patients. Methods The clinical data of 30 patients with soft tissue sarcoma who infiltrated the periarticular bone tissue in our center from May 2004 to October 2011 were retrospectively analyzed. There were 14 males and 16 females with an average age of 51 (17-75 years). 12 cases of malignant fibrous histiocytoma, 8 cases of liposarcoma, 4 cases of primitive neuroectodermal tumor (PNET), 2 cases of synovial sarcoma, acinar soft tissue sarcoma and malignant schwannoma. Of these, 10 were found in the proximal femur, 9 in the distal femur, 8 in the proximal humerus, 2 in the proximal tibia, and 1 in the entire femur. All patients were treated with extensive excision of the tumor along with the affected bone tissue and reconstruction of the bone defect with the tumor-type prosthesis. Regular review of limb function, X-ray, pulmonary CT, etc., and follow-up, including the incidence of postoperative complications, limb function recovery and oncology and living conditions. Results The patients were followed up for an average of 25 months (range 3-84 months). One patient had temporary peroneal nerve paralysis. Three patients were treated with debridement after wound healing. Among them, 1 patient was amputated due to deep infection, 4 cases of tumor recurrence, the local recurrence rate was 13.3%, of which 1 case underwent amputation. Overall lung metastases were 15 and lung metastases were found in 11 deaths, of which 3 were associated with bone metastases. Of the 14 patients who survived without tumor at the last follow-up, 5 had tumor-bearing survival. The average MSTS score was 90% in the proximal femur, 82% in the distal femur, 73% in the proximal tibia, 71% in the proximal humerus, and 60% in the femur. The 2-year and 5-year survival rates were 61.6% and 30.8% respectively. Conclusion Extensive excision of the affected bone with the tumor can achieve tumor-free border and reduce the recurrence rate. Tumor-type prosthesis reconstruction can restore good limb function. Huge limbs soft tissue sarcoma infiltration of bone tissue may be the prognosis of patients with poor prognosis.