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目的探讨原位微波消融术治疗骨肿瘤的常见并发症发生原因及防治策略。方法 2009年3月-2012年7月,采用原位微波消融术治疗骨肿瘤73例,其中54例符合标准纳入研究。男31例,女23例;年龄9～74岁,中位年龄27岁。恶性肿瘤37例,良性肿瘤17例。49例原发骨肿瘤参照Enneking分期标准:3期17例,ⅡA期13例,ⅡB期19例。总结患者术后并发症发生情况、治疗方法及转归。结果术后54例均获随访,随访时间12～40个月,平均24个月。21例(38.9%)出现7项手术相关并发症,其中3例出现2项及以上并发症。其中病理性骨折4例(7.4%),深部感染2例(3.7%),神经损伤7例(13.0%),下肢深静脉血栓形成1例(1.9%),膝关节内侧副韧带热损伤1例(1.9%),切口血肿2例(3.7%),切口脂肪液化、皮缘坏死8例(14.8%)。结论病理性骨折是导致原位微波消融术后再次手术的首要并发症,深部感染是造成保肢失败的主要并发症,神经损伤及切口愈合不良是最常见并发症,对微波高温的控制是手术成功的关键,相应的预防措施可降低并发症的发生。
Objective To investigate the causes and prevention strategies of the common complications of microwave ablation in the treatment of bone tumors. Methods From March 2009 to July 2012, 73 cases of bone tumors were treated by microwave ablation in situ, of which 54 cases were eligible for inclusion in the study. 31 males and 23 females; aged 9 to 74 years, mean age 27 years. 37 cases of malignant tumors, 17 cases of benign tumors. 49 cases of primary bone tumors with reference to Enneking staging criteria: 17 cases of stage 3, 13 cases of stage IIA, 19 cases of stage IIB. Summarize the occurrence of postoperative complications, treatment and outcome. Results All the 54 cases were followed up for 12 to 40 months with an average of 24 months. Seven of the 21 patients (38.9%) experienced surgery-related complications, of which 3 showed 2 or more complications. Pathological fractures were found in 4 cases (7.4%), deep infection in 2 cases (3.7%), nerve injury in 7 cases (13.0%), deep venous thrombosis in 1 case (1.9%), thermal injury in the medial collateral ligament in 1 case (1.9%), incision hematoma in 2 cases (3.7%), incision fat liquefaction and skin necrosis in 8 cases (14.8%). Conclusion Pathological fracture is the primary complication of reoperation after microwave ablation in situ. Deep infection is the main complication of limb salvage failure. Nerve injury and incision healing are the most common complication. The control of microwave hyperthermia is surgery The key to success, the corresponding preventive measures can reduce the incidence of complications.