1.骨巨细胞瘤好发年龄在20~40岁,性别差异不大;好发部位为股骨下端和胫骨上端。主要的症状为疼痛和肿胀,与病情的发展相关。局部包块压之有乒乓球样感觉,病变的关节活动受限。X线检查主要表现为骨端偏心位溶骨性破坏,常呈肥皂泡样改变,而无骨膜反应,病灶骨皮质膨胀变薄,呈肥皂泡样改变。该例年龄、临床症状、体征、X线表现之典型的肥皂泡样阴影,可确诊为骨巨细胞瘤。图示如下:
2.骨巨细胞瘤最佳的治疗方法为手术。根据骨肿瘤的外科分级,属G
![](https://assets.51tk.com/images/343383afdca68ae9_img/7e0abb3ae70a8c86.gif)
T
![](https://assets.51tk.com/images/343383afdca68ae9_img/7e9b4566a6bc417f.gif)
M
![](https://assets.51tk.com/images/343383afdca68ae9_img/65fdfc21dc0d2418.gif)
者,采用刮除术加灭活处理,在植入自体或异体松质骨或骨水泥,但易复发。对于复发者,应作切除或节段截除术或假体植入术;属G
![](https://assets.51tk.com/images/343383afdca68ae9_img/3140b3b8c0fc3b17.gif)
T
![](https://assets.51tk.com/images/343383afdca68ae9_img/bcf3a9e6af5c3413.gif)
M
![](https://assets.51tk.com/images/343383afdca68ae9_img/ef756a169a06119c.gif)
者,采用广泛或根治切除,化疗无效。
3.骨肉瘤属G
![](https://assets.51tk.com/images/343383afdca68ae9_img/783456a16ba5c7fc.gif)
T
![](https://assets.51tk.com/images/343383afdca68ae9_img/a5882cb26ea10472.gif)
M
![](https://assets.51tk.com/images/343383afdca68ae9_img/e7f137b8293455a8.gif)
者,采用综合治疗。术前大剂量化疗,然后根据肿瘤浸润范围作根治性切除瘤段、灭活再植,或植入假体的保肢手术,或截肢术,术后大剂量化疗。骨肉瘤肺转移的发生率极高,属G
![](https://assets.51tk.com/images/343383afdca68ae9_img/9750b2169350187f.gif)
T
![](https://assets.51tk.com/images/343383afdca68ae9_img/c4ff6e3295e64d64.gif)
M
![](https://assets.51tk.com/images/343383afdca68ae9_img/ebeb51719d4bb198.gif)
除上述治疗外,还可行手术切除转移灶。近年来,由于早期诊断和化疗迅速发展,骨肉瘤的5年成活率提高至50%以上。所以如果最终确诊为骨肉瘤,骨肉瘤应采用综合治疗,化疗一肿瘤切除一化疗。