背景:目前保肢治疗已成为四肢恶性骨肿瘤的规范治疗方式,但若治疗处理不当,则会造成肿瘤复发、继发性感染、内固定或重建假体松脱等并发症。目的:文章以传统的肢体转移性骨肿瘤外科治疗原则为基础,从四肢恶性转移性骨肿瘤患者的实际情况出发,制定人性化、个体化、简单化的姑息性治疗方案,观察骨水泥填充法结合内固定治疗转移性恶性骨肿瘤的合理性、临床疗效及预后情况。方法:回顾分析解放军第四二一医院骨科2008年1月至2009年6月收治的恶性转移性骨肿瘤患者中筛选的31例患者,均要求保肢治疗。将31例患者按治疗方式分为2组:肿瘤清除+钢板内固定组11例,采用骨水泥填充法结合钢板内固定内固定姑息性治疗;肿瘤清除+钢板内固定+固定前放化疗组20例,采用固定前放化疗结合钢板内固定保肢治疗。全部患者固定后获4-38个月随访,平均18个月。结果与结论:随访结果显示,肿瘤清除+钢板内固定组11例均存活、生活能自理,肢体运动功能良好;肿瘤清除+钢板内固定+固定前放化疗组20例患者中17例存活,3例分别于固定后第9,13个月因原发肿瘤的多脏器转移和自身条件较差、并发其他并发症而死亡。肿瘤清除+钢板内固定组保肢治疗后肢体神经及运动功能综合评分均较固定前提高至少1个级别以上。结果证实,对于转移性恶性骨肿瘤的保肢治疗可不采用放化疗技术,简单的骨水泥填充法结合内固定姑息性治疗的方法也有较好的效果。 BACKGROUND: At present, limb salvage has become a standard treatment for malignant bone tumors of extremities. However, if the treatment is not properly treated, complications such as tumor recurrence, secondary infection, internal fixation or prosthesis loosening will be caused. OBJECTIVE: Based on the principle of traditional surgical treatment of limb metastatic bone tumor, this paper, based on the actual situation of patients with malignant metastatic bone tumor of extremity, formulated a humane, individualized and simplified palliative treatment plan. Combination of internal fixation in the treatment of metastatic malignant bone tumor rationality, clinical efficacy and prognosis. Methods: 31 cases of malignant metastatic bone tumor patients who were admitted to Department of Orthopedics, the 41st Hospital of PLA, January 2008 to June 2009 were retrospectively analyzed, all of whom required limb salvage therapy. Thirty-one patients were divided into two groups according to the way of treatment: tumor clearance + internal fixation group (n = 11), bone cement filling method combined with internal fixation and internal fixation of palliative treatment; tumor clearance + internal fixation + For example, the use of fixed radiotherapy and chemotherapy combined with internal fixation of limb salvage treatment. All patients were fixed after 4-38 months of follow-up, an average of 18 months. RESULTS AND CONCLUSION: The results of follow-up showed that 11 cases of tumor clearance + internal fixation group survived, able to take care of themselves and had good limb movement function. Twenty-seven of 20 patients with tumor clearance + internal fixation + radiotherapy and fixed radiotherapy survived, 3 Cases were fixed at the 9th and 13th months due to multiple organ metastases of the primary tumor and poor self-condition, with other complications and death. Tumor clearance + internal fixation group after limb salvage treatment of limb nerve and motor function comprehensive score than before the fixed increase of at least 1 level above. The results confirmed that for metastatic malignant bone salvage limb salvage therapy may not use radiotherapy and chemotherapy technology, simple cement filling method combined with internal fixation palliative treatment methods have good results.