本研究旨在评估放射学(磁共振成像[MRI])发现的意义,外科,以及以前对骨旁骨肉瘤(POS)患者的肿瘤预后和功能预后的干预措施。回顾性分析了在我们机构中诊断为原发性POS的27例患者(8例男性/19例女性)。流行病学数据,活检方法,误诊/干预不当,并注意到诊断延迟。损伤最大圆周延伸,最大纵向延伸,髓内受累,并评估了MRI切片中的神经血管延伸,和切除类型(节段关节内/节段间期/半皮质),重建类型(生物/非生物),并注意到手术切缘。评估最后一次随访时的功能和肿瘤结果。平均年龄为31.6(12-73)岁,平均随访时间为80.8(24-270)个月。髓内受累百分比与最大圆周延伸百分比和最大纵向延伸有关。(p=0.006,p=0.005)髓内受累率≤10%提示无复发或转移。神经血管包裹与转移性疾病有关,深部感染,和并发症相关的手术(p=0.017,p=0.002,p=0.005)。最常见的切除类型为节段关节内切除(63%)。最大圆周延伸百分比,病变的最大纵向延伸,髓内受累百分比,神经血管包裹的MSTS评分较低(p=0.003,p=0.028,p=0.038,p=0.022).平均MSTS评分为81.1%(60-100%)。5年总生存率为96.3%,无局部复发生存率为77.2%,无转移生存率为69.4%。髓内受累的病变范围,神经血管束接近度,计划手术时,应考虑MRI上的最大骨膜周向延伸。
This study aimed to evaluate the significance of radiological (magnetic resonance imaging [MRI]) findings, surgical, and previous interventions on prognosis with oncological and functional outcome in patients with parosteal osteosarcoma (POS). Twenty-seven patients (8 male/19 female) who were operated with the diagnosis of primary POS in our institution were retrospectively reviewed. The epidemiological data, biopsy method, misdiagnosis/improper interventions, and delay in diagnosis were noted. The lesions\' maximum circumferential extension, maximum longitudinal extension, intramedullary involvement, and neurovascular extensions in MRI sections were evaluated, and the resection type (segmental intraarticular/segmental intercalary/hemicortical), reconstruction type (biologic/non-biologic), and surgical margins were noted. Functional and oncological results at the last follow-up were assessed. The mean age was 31.6 (12-73) years, and mean follow-up was 80.8 (24-270) months. Intramedullary involvement percentage was related with maximum circumferential extension percentage and maximum longitudinal extension. (p = 0.006, p = 0.005) The intramedullary involvement ratio of ≤ 10% suggested no recurrence or metastasis. The neurovascular encasement was related to metastatic disease, deep infections, and complication related surgeries (p = 0.017, p = 0.002, p = 0.005). The most common resection type was segmental intraarticular resection (63%). The maximum circumferential extension percentage, the maximum longitudinal extension of the lesion, intramedullary involvement percentage, and neurovascular encasement had lower MSTS scores (p = 0.003, p = 0.028, p = 0.038, p = 0.022). The mean MSTS score was 81.1% (60-100%). The 5-year overall survival was 96.3%, local recurrence-free survival was 77.2%, and metastasis-free survival was 69.4%. The lesions\' extent of intramedullary involvement, neurovascular bundle proximity, and maximum periosteal circumferential extension on MRI should be considered when planning the surgery.