腓骨骨膜瓣移植在儿童四肢骨肿瘤瘤段骨射线灭活回植术中的应用观察

目的 探讨腓骨骨膜瓣移植覆盖灭活瘤段骨断端在儿童四肢骨肿瘤射线灭活再植术中应用的可行性和临床效果。方法 回顾性分析2016年6月—2017年6月郑州大学附属肿瘤医院骨与软组织科8例原发四肢恶性或侵袭性骨肿瘤患儿临床资料,男4例、女4例,年龄9~17(13.6±2.5)岁;骨肉瘤5例,尤文肉瘤、软骨肉瘤、反复复发的侵袭性朗格汉斯组织细胞增生症各1例。均采用瘤段骨扩大切除+术中灭活自体瘤段骨回植术治疗,回植的瘤段骨断端均应用带蒂或游离腓骨骨膜瓣覆盖。肿瘤位于胫骨中上段5例,应用同侧带腓血管蒂腓骨膜瓣逆行转位覆盖瘤段骨远侧断端;肿瘤位于股骨中下段2例、肱骨中段1例,应用游离腓血管蒂腓骨膜瓣移植覆盖近侧断端。瘤段骨为单纯骨干5例,包含关节面3例,长度13~26(18.1±3.9)cm。灭活方法均为术中离体射线灭活。术后定期随访,拍摄X线、CT观察记录瘤段骨体内愈合情况,并观察患肢长度变化。结果 本组8例患儿术后随访12~24(18.8±3.5)个月。8例患儿共有13处断端均获得骨愈合,腓骨膜覆盖的断端平均愈合时间6~10(7.3±1.3)个月,且骨膜覆盖区域可观察到成骨现象。末次随访时,5例骨干灭活和1例骨关节灭活的患儿未发生双侧肢体不等长,2例骨关节灭活患儿患侧下肢长度较对侧短缩1.5 cm和2.0 cm。结论 在儿童四肢骨肿瘤手术治疗中,应用腓骨骨膜瓣移植覆盖灭活瘤段骨断端的方法可行,能够有效促进瘤段骨的愈合和防止骨不愈合、骨不连发生,且操作简便,并发症较少,推荐临床开展应用。

The application research of vascularized fibular periosteum grafting in irradiated bone segment replantation for treatment of limb bone tumor in children

Objective To investigate the feasibility and clinical effect of union promotion of vascularized fibular periosteum grafting, in irradiated bone segment replantation for treatment of limb bone tumor. Methods Eight cases of malignant or invasive bone tumors of the extremities were retrospectively analyzed in the Department of Bone and Soft Tissue, the Affiliated Cancer Hospital of Zhengzhou University, 4 males and 4 females, average age (13.6 ±2.5) years, ranged 9-17 years. There were 5 osteosarcoma, 1 Ewing sarcoma, 1 Langerhans cell histocytosis with recurrence several times, and 1 chondrosarcoma. All patients underwent enlarged resection of the tumor segment and intraoperative inactivation of the autologous tumor segment. The replanted tumor segment was covered with pedicle or free periosteal periosteal flap. The lesions were located in 5 tibia, covered the distal end of irradiated segment with ipsilateral pedicled fibular periosteum for union promotion;2 lesions were located in middle and distal femur, and 1 lesion was located in middle humerus, covered the proximal end of irradiated segment with free fibular periosteum. Average length of resect bone was ( 18. 1 ±3.9) cm, ranged 13-26 cm, constiuted of 3 osteoarticular segment and 5 intercalary segment. The method of inactivation of bone segment was intraoperative extra(、orporal irradiation. Regular postoperative fellow-up, X ray and CT were applied to observe bone union time, and the length of the affected limb were recorded. Results All patients were followed up by mean time of ( 18. 8 土 3.5) months, range 12-24 months. Thirteen ends of irradiated-host bone in 8 patients got union completely. The mean time to union of irradiated segment-host end covered by fibular periosteum was (7.3 ± 1.3) months, range 6-10 months, region of end covered by periosteum showed excellent osteogenic power. There was no leg length discrepancy occurred in 5 patients who received intercalary inactivation and 1 patient who received osteoarticular inactivation because of the preservation of growth plate or mature of growth plate, but 2 osteoarticular inactivated patients suffered leg length discrepancy of 1.5 cm and 2 cm respectively at last follow-up. Conclusions Transplantation of vascularized fibular periosteum can effectively promote the union of irradiated bone segment after replantation, prevent non-union, with simple operation and fewer complications in the surgical treatment of limb bone tumor in children.