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山东大学学报(医学版)

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MRI在骨肉瘤保肢术中应用的评价

杨强1,李建民1,杨志平1,李振峰1,迟增德2
  

  1. (1. 山东大学齐鲁医院骨外科, 山东 济南 250012; 2. 山东省千佛山医院骨外科, 山东 济南 250014)
  • 收稿日期:1900-01-01 修回日期:1900-01-01 发布日期:2009-04-16
  • 通讯作者: 李建民

Evaluation of MRI in limb salvage surgery on osteosarcoma

  1. (1. Department of Orthopaedics, Qilu Hospital of Shandong University, Jinan 250012, China;
    2. Department of Othopaedics, Shandong Qianfoshan Hospital, , Jinan 250014, China)
  • Received:1900-01-01 Revised:1900-01-01 Published:2009-04-16

摘要: 目的探讨膝关节周围骨肉瘤保肢术中MRI的应用及其临床意义。方法43例骨肉瘤患者,均行X线及MRI成像检查,对肿瘤进行外科分期,评价肿瘤在骨髓及周围软组织中的浸润范围,制定手术方案并定制假体,化疗结束后行瘤段切除定制人工假体置换术。术后对标本进行病理组织学检查,与MR成像进行对比分析。随访评估患肢的功能,并定期化疗。结果43例患者,Ⅱa期10例,Ⅱb期33例,均按术前制定方案顺利完成手术,术后平均功能恢复率为76.7%。骨肉瘤MRI上表现缺乏特异性,但在骨髓浸润的显示,肿瘤与肌肉、血管、神经、相邻关节的关系,跳跃病灶的显示及骨肉瘤内出血和坏死的显示,MRI具有无可比拟的优势。结论在骨肉瘤保肢术中MRI的应用具有重要意义,它可以为保肢手术提供丰富的信息,这对合理制定手术方案及保证手术效果有极大的临床价值。

关键词: 磁共振成像, 骨肿瘤, 外科手术

Abstract: To investigate the clinical significance of MRI in limb salvage surgery on osteosarcoma around the knee joint. Methods43 patients with osteosarcoma were examined by Xray and MRI, and were staged by Enneking surgical staging system. Based on the tumor extent in the medullary cavity and the surrounding soft tissues, the operative plans were formulated and the custom artificial prostheses were made. After chemotherapy, tumors were removed and custommade prostheses were put on. Postoperatively the histopathological results were compared with the MR images. Followed up for 10 to 55 months (mean 38 months), the function of the involved knee joints was evaluated. Results Of the 43 cases, 10 were in stage Ⅱa and 33 in stage Ⅱb, all were successfully operated on. The functional recovery rate was 76.7%. MRI was of little diagnostic value in manifesting osteosarcoma, but was of great value in demonstrating intramedullary extension, skip metastasis, the relationship of bone tumor to vessel, nerve, muscle and adjacent joints, bleeding and necrosis in osteosarcoma. ConclusionMRI has great values in making operative plans and ensuring the operative outcome in limb salvage surgery on osteosarcoma.

Key words: MRI, Osteosarcoma, Surgical procedures,operative

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