新辅助化疗结合肿瘤型人工膝关节置换治疗膝关节周围骨肉瘤的临床效果

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Abstract Objective To explore the clinical effect of neoadjuvant chemotherapy combined with the replacement of tumor-type artificial knee joint treating osteosarcoma around the knee joint.Methods From February 2003 to November 2014,30 patients with osteosarcoma around the knee joint inⅡBstage were diagnosed by piration biopsy.Patients were treated by neoadjuvant chemotherapy for 1-2 cycle before operation,and drugs included Doxorubicin,Cisplatin,high dose of Methotrexate and Ifosfamide,and patients were given extensive resection of tumor and tumor prosthesis rebuilt,they were given adjuvant chemotheapy for 4-5 cycle after operation.Treatment effect was observed.Results All 30 patients completed preoperative neoadjuvant chemotherapy,extensive tumor resection,replacement of tumor-type artificial knee joint and postoperative chemotherapy.Patientswere followed-up for 12-152months,average(58.10±45.51)months,4 patients(13.3％)had local recurrence,8 patients(26.7％)had pulmonarymetastasis,7 patients(23.3％)died and 23 patients(76.7％)survivied,22 patients(73.3％)survived tumor-free and 1 case(3.4％)survived with tumor,the overall 5-year survival rate was 69.6％.Postoperative pathological HuvosⅡlevel in 14 cases(46.7％),HuvosⅢlevel 16 cases (53.3％),HuvosⅢlevelwith better prognosis than HuvosⅡlevel（P＜0.05).Local recurrence caseswent amputation with no local recurrence at the end of follow-up,themean MSTS function score was(27.4±3.5)points after sixmonths operation.1-year survival rate of prosthesis was 93.3％, 5-year survival rate was 80.2％,average(55.4±47.5) months,the related complication of prostheses was 5 cases（16.7％）,including peri-prosthesis infection in 1 patient(3.3％),aseptic loosening of prostheses in 3 patients (10.0％),prosthesis fracture in 1 patient(3.3％).Conclusion Neoadjuvant chemotherapy combined with the replacement of tumor-type artificial knee joint treating osteosarcoma around the knee joint is an effectivemethod for osteosarcoma around the knee,can obtain good control of the tumor and limb function,also has lower incidence of complications.

Key words： Osteosarcoma Neoadjuvant chemotherapy Limb salvage Tumor prosthesis

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	HUANG Hai

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HUANG Hai. Clinical effect of neoad juvant chemotherapy combined w ith the rep lacement of tumor-type artificial knee joint treating osteosarcoma around the knee joint[J]. 中国当代医药, 2016, 23(32): 68-72.

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http://dangdaiyiyao.com/EN/ OR http://dangdaiyiyao.com/EN/Y2016/V23/I32/68

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