保留骨骺灭活再植术治疗儿童股骨远端骨肉瘤的远期疗效

目的探讨保留骨骺灭活再植术的远期临床疗效及并发症的治疗。方法回顾10年间随访超过5年的5例股骨远端骨肉瘤患者，男1例，女4例。平均年龄9．2岁。MR分型：I型3例，II型2例。1例合并病理骨折。治疗方法均采用术前化疗2疗程＋保留骨骺灭活再植手术＋术后化疗。结果5例患者平均随访82个月（60～126个月）。无复发、转移和死亡。3例发生灭活骨骨折，均再次行植骨内固定术，再次术后半年骨愈合良好。患膝屈曲≥110°3例，90°1例，70°1例。双下肢等长1例，患肢短缩〈2cm3例，8cm1例。肢体功能评分为13～30分，平均25．6分。结论保留骨骺的灭活再植术是一种可行的手术方法，可有满意的临床疗效。关节活动受限和灭活骨骨折是该手术的最常见远期并发症。

Long-term outcomes of inactivated bone replant with preservation of the epiphysis for children with osteosarcoma In distal femur

Objective To study the long-term outcomes of inactivated bone replant with preservation of the epiphysis for children with osteosarcoma who underwent limb salvage. Methods 5 children with osteosarcoma, 1 male and 4 female, aged 9.2 in average, who were followed up for more than 5 years, and treated in the past 10 years were retrospectively Studied. They underwent inactivated bone replant with the epiphysis preserved. MR classification was type I （n=3） and type II （n=2）. One patient also had pathological fracture. All patients underwent 2 courses of preoperative Chemotherapy, replant and 6 courses of postoperative chemotherapy. Results 5 patients were followed up for 60 to 126 months, 82 months in average. No recurrence or metastases occurred. All patients survived. 3 patients had fracture in the inactivated bone, and were treated with open reduction, bone grafting and internal fixation. The bone healed well 6 months after reoperation. The flection of the affected knee was ≥ 110° in 3 patients, 90° in 1 patient, and 70° in 1 patient. 1 patient＇s legs were isometric. 3 patients＇ affected legs shortened by less than 2cm, and 1 patient＇s affected leg shortened by 8cm. The mean functional score of the affected limbs was 25.6 （13 to 30 points）. Conclusions Inactivated bone replant with the preservation of epiphysis for osteosarcoma in children was effective to regain limb function and keep the length of limb. We must examine the bone substance of the affected bone and the invasion scope of the lesion preoperatively. During operation, bone grafting between the inactivated and the host bone must be treated carefully. Once the complication occurred, it must be treated immediately to get good results. The most common longterm complications are knee motion limitation and inactivated bone fracture.