بررسي نتايج اعمال جراحي حفظ اندام در بيماران مبتلا به استيوساركوم با درجه بدخيمي بالا

THE RESULTS OF LIMB-SALVAGE PROCEDURES FOR HIGH GRADE OSTEOSARCOMA OF THE LIMBS

Osteosarcoma is the most common type of bone cancer that involves adolescents and young people. Amputation is usually proposed by some surgeons after diagnosis which is not acceptable for the patients. In this article, the results of limb-salvage procedures for patients with high-grade malignant osteosarcoma were investigated. The survival rate, functionality of limb, and complications of the procedures were studied. Four approaches were used for reconstruction of limbs after removal of tumor: osteoarticular allografts, intercalary allografts, allograft with prosthesis, and prosthesis without allograft (custom-made prosthesis). Limb-salvage procedure was performed on 107 patients with high-grade malignant osteosarcoma of limbs (except pelvis) during 1995-2000. The patients were followed and assessed for a period of 2 to 5 years (average of 37 months). Seventy-five patients(70%) were alive and without evidence of local recurrence as distant metastases after the follow-up period. Bone intercalary approach showed excellent functionality for 80% of the patients, using Mankin functional evaluation system. Osteoarticular and prosthesis without allograft showed good functionality in 81.5% and 75% of the patients respectively. Overally, complications of the procedures, including fracture of the plate and screws, fracture of allograft, and infection happened in 48%, 44.7%, 12.5%, and 0% of the patients treated with intercalary allograft, osteoarticular allograft, prosthesis without allograft, and allograft with prosthesis, respectively.