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style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">骨肉瘤是最常见的骨恶性肿瘤，它来源于有成骨潜能的间叶细胞，由恶性增殖的肉瘤细胞直接产生肿瘤性骨样组织或不成熟骨，也称为成骨肉瘤，是指瘤细胞能直接产生肿瘤骨及骨样组织的一种恶性结缔组织肿瘤。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">1993 年，世界卫生组织 WHO 为避免「成骨」在「来源」和「产生」两种意义上造成的混乱而将其统称为骨肉瘤。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","⚕️","2026-08-03",{"key":90,"title":91,"html":92,"icon":93,"updatedAt":88},"Symptoms","症状表现","\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">骨肉瘤的突出症状是肿瘤部位的疼痛，由肿瘤组织浸蚀和溶解骨皮质所致。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>（\u003C\u002Fstrong>\u003Cstrong>1\u003C\u002Fstrong>\u003Cstrong>）\u003C\u002Fstrong>\u003Cstrong>疼痛：\u003C\u002Fstrong>肿瘤部位发生不同程度的疼痛是骨肉瘤非常常见和明显的症状，由膨胀的肿瘤组织破坏骨皮质，刺激骨膜神经末梢引起。疼痛可由早期的间歇性发展为数周后的持续性，疼痛的程度可有所增强。下肢疼痛可出现避痛性跛行。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>（\u003C\u002Fstrong>\u003Cstrong>2\u003C\u002Fstrong>\u003Cstrong>）\u003C\u002Fstrong>\u003Cstrong>肿块：\u003C\u002Fstrong>随着病情发展，局部可出现肿胀，在肢体疼痛部位触及肿块，伴明显的压痛。肿块增长迅速者，可以从外观上发现肿块。肿块表面皮温增高和浅表静脉显露，肿块表面和附近软组织可有不同程度的压痛。因骨化程度的不同，肿块的硬度各异。肿块增大，造成关节活动受限和肌肉萎缩。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>（\u003C\u002Fstrong>\u003Cstrong>3\u003C\u002Fstrong>\u003Cstrong>）\u003C\u002Fstrong>\u003Cstrong>跛行：\u003C\u002Fstrong>由肢体疼痛而引发的避痛性跛行，随着病情的进展而加重，患病时间长者可以出现关节活动受限和肌肉萎缩。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>（\u003C\u002Fstrong>\u003Cstrong>4\u003C\u002Fstrong>\u003Cstrong>）\u003C\u002Fstrong>\u003Cstrong>全身状况：\u003C\u002Fstrong>诊断明确时，全身状况一般较差，表现为发热、不适、体重下降、贫血以至衰竭。个别病例肿瘤增长很快，早期就发生肺部转移，致全身状况恶化。瘤体部位的病理骨折使症状更加明显。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","📋",{"key":95,"title":96,"html":97,"icon":98,"updatedAt":88},"causes","病因分析","\u003Cp style=\";text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">骨肉瘤发病高峰年龄为 15~25 岁，男女比例 1.5:1。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\";text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">环境污染、生活习惯和饮食等没有明显的相关性。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\";text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">创伤不能引起骨肉瘤，但有的患者是因为创伤而发现了骨肉瘤。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\";text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">身材高大的人群比身材矮小的人群骨肉瘤的发病率高，可能与青春期增长速度过快有关。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\";text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">中年后发生骨肉瘤与畸形性骨炎（Paget 病）有关，放射性损伤可能继发骨肉瘤，纤维结构不良可能恶变为骨肉瘤。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\";text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">Li-Fraumeni 综合征（遗传性 p53 基因突变）和遗传性视网膜母细胞瘤（RB 基因突变）易继发骨肉瘤。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","🧬",{"key":100,"title":101,"html":102,"icon":103,"updatedAt":88},"diagnosis","诊断检查","\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">到现在为止我们对肿瘤的诊断还是三种方法，第一个是临床检查，也就是医生的问诊和体格检查；第二个是拍片子，现在有 X 光片、CT、磁共振、骨扫描等，都能帮医生明确地诊断骨肉瘤；最重要的方法是病理诊断。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\";text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">现在有很多肿瘤病灶活检的方法，包括穿刺，或者做一个小的切口，取出一些组织来作病理检查。临床、影像、病理三结合是确诊骨肉瘤的重要方法。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">骨肉瘤患者入院应做全面化验检查，包括血、尿、便、肝、肾功能等，以作为诊断及治疗的参考。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">对骨肉瘤病人，通常采用血沉、碱性磷酸酶、微量元素分析铜、锌比作为动态观察指标。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>（\u003C\u002Fstrong>\u003Cstrong>1\u003C\u002Fstrong>\u003Cstrong>）\u003C\u002Fstrong>\u003Cstrong>血沉：\u003C\u002Fstrong>骨肉瘤早期、硬化型骨肉瘤、分化较好骨肉瘤血沉可在正常范围内。瘤体过大、分化差、有转移者血沉加快。血沉可以作为骨肉瘤发展过程中动态观察指标，但并不十分敏感。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>（\u003C\u002Fstrong>\u003Cstrong>2\u003C\u002Fstrong>\u003Cstrong>）\u003C\u002Fstrong>\u003Cstrong>碱性磷酸酶：\u003C\u002Fstrong>碱性磷酸酶的检查最有意义，其水平的变化与肿瘤性骨细胞的活跃程度有密切关系，对判断患者的预后也有一定的价值。但在儿童，由于生长发育旺盛，可影响碱性磷酸酶的临床意义。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">\u003Cstrong>（\u003C\u002Fstrong>\u003Cstrong>3\u003C\u002Fstrong>\u003Cstrong>）\u003C\u002Fstrong>\u003Cstrong>血清铜、锌及铜锌比：\u003C\u002Fstrong>血清铜及锌元素是机体生长、发育的重要物质。采用原子吸收光谱测定血清内酮、锌的含量，有助于成骨肉瘤的诊断、疗效观察、预后判断。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">病理诊断是肿瘤疾病诊断的金标准，有了明确的组织学诊断，才能确定治疗方案。术前活检非常重要，是手术治疗的一部分，应由有经验的医生进行，因为不恰当的活检可以丧失保留肢体的机会。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">针吸活检有肿瘤污染风险小和危险性小的优点，其诊断阳性率在有经验的医院可高达 80% 以上。如果针吸活检失败，则应尽早进行切开活检。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","🩺",{"key":105,"title":106,"html":107,"icon":108,"updatedAt":88},"treatment","治疗方式","\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">骨肉瘤的治疗以大剂量个体化新辅助化疗（在术前化疗）和手术为主。目前，在新辅助化疗和正确的手术方案的基础上，5 年无瘤生存率可以达到 50％～70％。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">手术的方案应根据术前化疗的效果及肿瘤的外科分期而定。此外，还要参考病人、家庭的意愿，病人的年龄、心理状态，肿瘤的部位、大小，软组织、神经血管束的情况，可预见的术后功能等。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\"> \u003C\u002Fspan>\u003C\u002Fp>\u003Cp style=\"text-autospace:ideograph-numeric;\">\u003Cspan style=\"font-size: 15px;\">有计划地、合理地应用现有的治疗手段，以期最大幅度地根治、控制肿瘤，提高治愈率，改善病人的生活质量。\u003C\u002Fspan>\u003C\u002Fp>\u003Cp>\u003Cbr\u002F>\u003C\u002Fp>","💊",{"author":110,"reviewedBy":110,"lastReviewed":110,"datePublished":110,"citations":111,"disclaimer":110},"",[112,114],{"title":113},"郝希山，魏于全.肿瘤学[M].北京:人民卫生出版社，2010.",{"title":115},"魏于全，赫捷.肿瘤学[M].第2版.北京:人民卫生出版社，2015.",false,1789384125758]