骨肉瘤_____骨肉瘤；保肢术；MRI；广泛切除

骨肉瘤髓腔内侵袭范围MRI测量与确定合理截骨平面的相关研究

http://www.100md.com 《中国矫形外科杂志》 2005年第23期

骨肉瘤,,骨肉瘤；保肢术；MRI；广泛切除,1资料与方法,2结果,3讨论,参考文献：

     摘要：[目的]探讨磁共振成像(MRI)确定肢体骨肉瘤在髓腔内侵袭范围的准确性及据此决定保肢术中合理截骨平面的可靠性。[方法]25例骨肉瘤患者，股骨远端15例，胫骨近端10例，均行瘤段切除定制人工假体置换术，截骨平面为MRI所示肿瘤骨干侧边界外30 mm处。术后对所有患者进行随访，对患者下肢的功能进行评估。通过术前MRI、X线和术后标本的肉眼及病理测量确定肿瘤在髓腔内的侵袭范围。对所得数据进行统计学分析。[结果]25例患者随访5~36个月，平均155个月，膝关节活动度0～120°，股骨假体的活动度优于胫骨假体活动度。按Enneking肌肉骨骼肿瘤术后下肢功能评分标准，平均功能恢复率为80%。所测得肿瘤在髓腔内的侵袭范围分别为(1074±345)、(786±256)、(926±205)、(1043±328)mm。统计学分析表明磁共振图像所确定的肿瘤髓内侵袭范围与实际范围2组数据之间无显著性差异。[结论]应用MRI确定骨肉瘤髓内侵袭范围有较高准确性，以此作为判断骨肉瘤手术时切除边界的参考是可靠的。经短期随访证实，在MRI确定的肿瘤髓内边界外30 mm处作为保肢术中的截骨平面是安全和有利于肢体功能重建的。

    关键词：骨肉瘤；保肢术；MRI；广泛切除

    Study of measuring intramedullary osteosarcoma extension on MRI and determining reasonable osteotomy plane

    LI Jianmin,YANG Qiang,YANG Zhiping,et al

    Depatment of Orthopaedics,Qilu Hospital of Shandong University,Jinan Shandong 250012

    Abstract：[Objective]To investigate the accuracy of osteosarcema extension in medullary cavity and the reliability of osteotomy plane defining on MRI[Method]Twentyfive patients with osteosarcona,15 cases in distal femur and 10 cases in proximal tibia were operated with segmental resection and custommade prostheses replacementThe osteotomy plane were defined as the margins on T1 weighted images plus 30 mmThe extension scope in medullary cavity was measured on MRI,plain radiographs and through naked eyes and pathologic examinationThe data were analysed statistically[Result]Among the 25 cases,followed up ranged from 5 months to 36 months (mean 155 months)The spheres of the knee activity were 0～ 120°,the average rate of functional recovery was 80% according to Ennektng functional evaluation system for musculoskeletal tumorThe extention scope in medullary cavity measured on MR images was(1074±345)mm,(786±256)mm on plain radiographs and(926±205)mm measured in naked eyesThe actual extension scope in medullary cavity was(1043±328)mmThere was not significant difference between the extensional scope measured on MRI images and the actual scope through statistical analysis,and the former was slightly bigger than the later[Conclusion]The aggressive extension could be measured correctly on MRI,according to which,it is reliable to estimate the surgical marginsIt is safe and good for cuting off the bone 30 mm out of the edge confirmed by MRI according to the result of short term followup ......

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