目的 探讨距骨原发骨肿瘤及瘤样病变的发病特点﹑治疗方法和预后。
方法 回顾分析了1993年－2008年我院收治的21例距骨原发骨肿瘤及瘤样病变病人的临床资料，随访病人，并按肌肉骨肿瘤协会(MSTS)的标准进行评分。
结果 21例病人中有骨巨细胞瘤病人7例、软骨母细胞瘤病人10例、骨样骨瘤、动脉瘤样骨囊肿、单纯骨囊肿、骨纤维结构不良各1例。7例骨巨细胞瘤病人的发病年龄为20-33岁，平均24岁。7例病人影像学均为溶骨性破坏，基质中无钙化。外院术后复发再来我院就诊3例，其中2例行距骨切除跟骨胫骨融合术，而另1例行小腿截肢术；4例我院初诊病人，均行病灶刮除术。7例病人中有3例病人得到长期随访，其中2例为我院初次手术病人，行病灶刮除术，术后随访10个月和32个月未复发；另一例为术后复发病人，行距骨切除胫骨跟骨融合术病人，再次术后随访36个月未复发。功能评分分别为29分、26分和24分。10例软骨母细胞瘤病人的发病年龄为10-35岁，平均22岁。除1例行病灶刮除骨水泥填充外，另外9例均行病灶刮除植骨术。10例病人中9例病人有完整的随访资料，无复发病人。随访时间为：15-87月，中位随访时间为36月。功能评分均为30分。其余4例其它病人中，1例骨样骨瘤病人行局部切除植骨术外，另外3例病人均行病灶刮除植骨术，术后无复发。
结论 距骨发病率高的原发骨肿瘤为软骨母细胞瘤和骨巨细胞瘤。距骨软骨母细胞瘤病人发病年龄较大，病灶刮除植骨术是其治疗方法，；而骨巨细胞瘤患者行刮除术后，有一定的复发率。距骨切除可降低局部复发率。距骨骨巨细胞瘤的治疗有一定的困难。

 

 

Objective Analysis the clinical features、treatments and prognosis in the primary bone tumors and tumor-like lesions in the talus.  Methods.  Twenty-one patients of primary bone tumors and tumor-like lesions of the talus between 1993 and 2008 are reviewed in our hospital. And then we follow up these patients and evaluate the function of every patient according to the criteria of musculoskeletal tumor society (MSTS).  Results.  In all twenty-one patients there are seven giant cell tumors 、ten chondroblastomas 、one osteoid osteoma 、one aneurismal bone cyst and one fibrous dysplasia. The ages range of seven giant cell tumors are from twenty to thirty-three years old, mean twenty-four years old. In the seven patients, there are three patients, who have received surgery in other hospitals and relapsed. In our hospital the two patients accepted talus resection and ankle fusion, and another amputation. Four patients, who received surgery first in our hospital, accepted curettage. Three patients are followed up long time in the seven giant cell tumors. The follow-up time separately are ten months、thirty-two months and thirty-six months. The function score(MSTS) are twenty-nine、twenty-six and twenty-four. The ages of ten chondroblastomas are from ten years old to thirty-five years old, average twenty-two years old. Nine patients accept curettage and bone grafting except one patient with bone cement. Nine patients have complete follow-up data in the ten patients. All patients function score are thirty. No one patient relapse. The follow-up time is from fifteen months to eighty-seven months, median follow-up time thirty-six months. In all other four patients, three patients accept curettage and bone grafting. However the osteoid osteoma patient accepts resection of the lesion, other three patients curettage and bone grafting. The four patient do not relapse. Conclusion The most common primary bone tumor in talus are chondroblastoma and giant cell tumor. The age of chondroblastoma in talus is older than that in other site. Curettage and bone grafting is satisfactory therapy for chondroblastoma in talus. All patients do not relapse. The function is good. However giant cell tumors accept curettage, some patient may relapse. Talectomy can decrease the relapse. The therapy of giant cell tumor in talus is difficulty.

Kyewords:距骨；原发骨肿瘤；瘤样病变；治疗；预后