【摘要】：背景雖然軟骨母細(xì)胞瘤是一種較少見的發(fā)生于骨骺的良性腫瘤,但其局部復(fù)發(fā)率較高,甚至發(fā)生遠(yuǎn)處轉(zhuǎn)移,傳統(tǒng)手術(shù)(主要是病灶刮除聯(lián)合植骨或骨水泥)治療后仍有一定復(fù)發(fā)率,術(shù)中輔助治療可有效降低術(shù)后復(fù)發(fā)率,而傳統(tǒng)手術(shù)聯(lián)合術(shù)中輔助治療軟骨母細(xì)胞瘤的大樣本研究少有報(bào)道。目的探討傳統(tǒng)手術(shù)聯(lián)合術(shù)中輔助治療軟骨母細(xì)胞瘤的臨床療效。方法對(duì)2005年8月至2016年4月收治的62例軟骨母細(xì)胞瘤病例的手術(shù)治療進(jìn)行回顧性分析,所有患者術(shù)前經(jīng)詳細(xì)的影像學(xué)評(píng)估后行傳統(tǒng)手術(shù)聯(lián)合術(shù)中輔助治療。所有病例最終診斷以術(shù)后常規(guī)病理診斷為準(zhǔn)。觀察術(shù)后有無病灶復(fù)發(fā)、植骨愈合情況以及骨骺未閉合者的患肢長(zhǎng)度。結(jié)果本組患者年齡最小9歲,最大48歲,平均19歲;男性48例,女性14例。病變位于股骨27例,脛骨19例,髕骨、肱骨、跟骨和髖臼各3例,距骨、跖骨、髂骨和肩胛骨各1例。隨訪時(shí)間為6個(gè)月到134個(gè)月,平均54個(gè)月。至隨訪結(jié)束時(shí)僅1例脛骨上段軟骨母細(xì)胞瘤患者經(jīng)腫瘤刮除滅活、植入、后交叉韌帶止點(diǎn)重建術(shù)后17個(gè)月出現(xiàn)局部復(fù)發(fā),再次刮除滅活,骨水泥填充手術(shù)治療,至隨訪結(jié)束共5個(gè)月未見局部復(fù)發(fā)。本組局部復(fù)發(fā)率為1.6%,其他患者均未出現(xiàn)局部復(fù)發(fā)及遠(yuǎn)處轉(zhuǎn)移。1例位于脛骨上段的軟骨母細(xì)胞瘤患者術(shù)后日�；顒�(dòng)時(shí)感輕度疼痛,膝關(guān)節(jié)活動(dòng)范圍無明顯受限,能獨(dú)立完成日�；顒�(dòng)。其余患者無明顯疼痛,日常工作及活動(dòng)無明顯受限。1例患者術(shù)后雙下肢不等長(zhǎng),患肢短縮2cm,對(duì)活動(dòng)無明顯影響;其余患者術(shù)后無明顯短縮,日�；顒�(dòng)無影響。結(jié)論傳統(tǒng)手術(shù)聯(lián)合術(shù)中輔助治療軟骨母細(xì)胞瘤可取得良好的臨床療效。
[Abstract]:Background although chondroblastoma is a rare benign tumor in epiphysis, its local recurrence rate is high and even distant metastasis occurs. The recurrence rate of traditional surgery (mainly focus curettage combined with bone graft or bone cement) is still high, and adjuvant treatment during operation can effectively reduce the recurrence rate after operation. However, a large sample of conventional surgery combined with intraoperative adjuvant treatment of chondroblastoma is rarely reported. Objective to investigate the clinical effect of traditional surgery combined with intraoperative adjuvant treatment of chondroblastoma. Methods the surgical treatment of 62 cases of chondroblastoma from August 2005 to April 2016 was analyzed retrospectively. The final diagnosis of all cases was based on the postoperative routine pathological diagnosis. Postoperative recurrence, bone graft healing and limb length in patients with unclosed epiphysis were observed. Results the age of the patients was the youngest 9 years, the oldest 48 years, the average 19 years old, male 48 cases, female 14 cases. The lesions were located in 27 cases of femur, 19 cases of tibia, 3 cases of patella, humerus, 3 cases of calcaneus and acetabular, 1 case of talus, 1 case of metatarsal bone, 1 case of iliac bone and 1 case of scapular bone. The follow-up period ranged from 6 months to 134 months (mean 54 months). Up to the end of follow-up, only one case of chondroblastoma of the upper tibia was curettage and inactivated, implanted, local recurred 17 months after posterior cruciate ligament reconstruction, and was again curettage and inactivated, bone cement filling operation. No local recurrence was found at the end of follow-up for 5 months. The local recurrence rate was 1.6 in this group. None of the other patients had local recurrence or distant metastasis. 1 cases of chondroblastoma located in the upper tibia had mild pain in daily activities after operation, and the range of knee joint movement was not significantly limited. Be able to complete daily activities independently. There was no obvious pain in other patients, and there was no obvious limitation in daily work and activity. 1 cases had no significant effect on the activity of lower extremities and 2 cm contraction of the affected limbs, while the other patients had no obvious shortening and no effect on daily activities. Conclusion traditional surgery combined with intraoperative adjuvant treatment of chondroblastoma can obtain good clinical effect.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R738.3
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本文編號(hào)：2195098