骨肿瘤的骨内切除术:我们的经验

V. V. Teplyakov, S. V. Dobrosotsky, A. Shaposhnikov, A. V. Lazukin, A. P. Ukhvarkin, E. A. Saprykina, V. Solodky
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Between 2015 and 2023, 45 interventions of intraosseous resection were performed in 44 patients: 19 (43 %) had enchondroma, 6 (14 %) – giant cell tumor, 4 (9 %) – fibrous dysplasia, 3 (7 %) – solitary bone cyst, 3 (7 %) – aneurysmal bone cyst, 2 (5 %) – chondromyxoid fibroma, 4 (9 %) – metastatic bone lesions, 1 (2 %) – osteoid osteoma, 1 (2 %) – benign fibrous histiocytoma, 1 (2 %) – chondrosarcoma G1 . Among them, 27 interventions were performed in combination with adjuvants (liquid nitrogen cryoablation, argon plasma coagulation, hydrogen peroxide, ethanol). In 24 patients, reconstruction was performed using lyophilized corpse bones, in 5 using autotransplant (fragments of the iliac crest), in 10 using plastic material (in 6 – polymethacrylate, in 4 – osseointegrative material “Rekost”), in 6 using xenoplastic material “Silorif.” Additionally, 16 surgeries were augmented with osteosynthesis (14 extramedullary and 3 intramedullary osteosyntheses).Results. Complications in the early postoperative period were observed in 3 (7 %) patients, in the late postoperative period in 2 (5 %) patients. At follow ups (between 2 and 97 months), 42 (95 %) patients did not have signs of recurrence. Musculoskeletal Tumor Society Score (MSTS) at these follow ups in recurrence-free patients was excellent (mean score – 93.6 %) and good (mean score – 77 %). Eastern Cooperative Oncology Group (ECOG) performance status also showed high functional potential of intraosseous resection: its mean value was 0.3.Conclusion. Use of intraosseous resection including augmentation with adjuvant measures, allowed to achieve excellent functional results in 42 (95 %) of patients with mean follow-up duration of 39.8 months. Fractures in 2 patients demonstrate the necessity of extramedullary osteosynthesis in surgeries on long bones experiencing high load irrespective of the volume of intervention. 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摘要

导言。对良性、边缘性和恶性骨肿瘤患者进行高效手术干预的有效性仍然是一个重要课题,因为此类手术意味着更低的损伤率和手术干预量,同时更符合生理。就根治性和复发率而言,它们可与创伤更大的手术相媲美,如节段切除和各种类型的重建(关节置换术、内假体、使用骨碎片的自体和异体移植等)以及截肢手术。分析良性、恶性、巨细胞和转移性骨肿瘤的骨内切除术效果。2015 年至 2023 年间,对 44 名患者进行了 45 次骨内切除术:19例(43%)为软骨瘤,6例(14%)为巨细胞瘤,4例(9%)为纤维发育不良,3例(7%)为单发骨囊肿,3例(7%)为动脉瘤性骨囊肿、2(5 %)-软骨样纤维瘤,4(9 %)-转移性骨病变,1(2 %)-类骨瘤,1(2 %)-良性纤维组织细胞瘤,1(2 %)-软骨肉瘤 G1。其中,27 例患者的手术结合了辅助治疗(液氮冷冻消融、氩等离子凝固、过氧化氢、乙醇)。24名患者使用冻干尸骨进行了重建,5名患者使用自体移植(髂嵴碎片),10名患者使用塑料材料(6名患者使用聚甲基丙烯酸酯,4名患者使用骨结合材料 "Rekost"),6名患者使用异种塑料材料 "Silorif"。此外,16 例手术采用了骨合成技术(14 例髓外骨合成,3 例髓内骨合成)。术后早期出现并发症的患者有 3 例(7%),术后晚期有 2 例(5%)。在随访期间(2至97个月),42名患者(95%)没有出现复发迹象。在这些随访中,无复发患者的肌肉骨骼肿瘤协会评分(MSTS)为优(平均分-93.6%)和良(平均分-77%)。东部合作肿瘤学组(ECOG)的表现状态也显示了骨内切除术的高功能潜力:其平均值为 0.3。42例(95%)患者采用骨内切除术,包括辅助措施,取得了极佳的功能效果,平均随访时间为39.8个月。2 名患者的骨折表明,无论干预量有多大,在对承受高负荷的长骨进行手术时,都有必要进行髓外骨合成。获得的结果表明,骨内切除术的适用性和有效性很高。对于某些适应症,它可以作为首选治疗方法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intraosseous resection of bone tumors: our experience
Introduction. The effectiveness of efficient surgical interventions in patients with benign, borderline, and malignant bone tumors remains an important topic because such operations imply lower injury rate and volume of surgical intervention while being more physiological. In terms of radicality and consequently recurrence rates they are comparable to more traumatic surgeries such as segmental resections with various types of reconstructions (arthrodesis, endoprosthesis, auto- and allotransplantation using bone fragments, et al) and amputation.Aim. To analyze the results of intraosseous resection for benign, malignant, giant cell, and metastatic bone tumors.Materials and methods. Between 2015 and 2023, 45 interventions of intraosseous resection were performed in 44 patients: 19 (43 %) had enchondroma, 6 (14 %) – giant cell tumor, 4 (9 %) – fibrous dysplasia, 3 (7 %) – solitary bone cyst, 3 (7 %) – aneurysmal bone cyst, 2 (5 %) – chondromyxoid fibroma, 4 (9 %) – metastatic bone lesions, 1 (2 %) – osteoid osteoma, 1 (2 %) – benign fibrous histiocytoma, 1 (2 %) – chondrosarcoma G1 . Among them, 27 interventions were performed in combination with adjuvants (liquid nitrogen cryoablation, argon plasma coagulation, hydrogen peroxide, ethanol). In 24 patients, reconstruction was performed using lyophilized corpse bones, in 5 using autotransplant (fragments of the iliac crest), in 10 using plastic material (in 6 – polymethacrylate, in 4 – osseointegrative material “Rekost”), in 6 using xenoplastic material “Silorif.” Additionally, 16 surgeries were augmented with osteosynthesis (14 extramedullary and 3 intramedullary osteosyntheses).Results. Complications in the early postoperative period were observed in 3 (7 %) patients, in the late postoperative period in 2 (5 %) patients. At follow ups (between 2 and 97 months), 42 (95 %) patients did not have signs of recurrence. Musculoskeletal Tumor Society Score (MSTS) at these follow ups in recurrence-free patients was excellent (mean score – 93.6 %) and good (mean score – 77 %). Eastern Cooperative Oncology Group (ECOG) performance status also showed high functional potential of intraosseous resection: its mean value was 0.3.Conclusion. Use of intraosseous resection including augmentation with adjuvant measures, allowed to achieve excellent functional results in 42 (95 %) of patients with mean follow-up duration of 39.8 months. Fractures in 2 patients demonstrate the necessity of extramedullary osteosynthesis in surgeries on long bones experiencing high load irrespective of the volume of intervention. The obtained results show applicability and high effectiveness of intraosseous resection. For certain indications, it can be the treatment of choice.
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