可延长假体在儿童恶性骨肿瘤保肢术中的应用

目的 探讨可延长假体在儿童恶性骨肿瘤保肢术中的初步应用效果.方法 回顾性分析2002年1月至2007年12月我科收治的22例原发性恶性骨肿瘤患儿,应用可延长假体开展保肢手术.女11例,男11例;平均年龄10.7(6～13)岁.部位:股骨下段18例,胫骨上段3例,股骨上段1例.骨肉瘤20例,尤文肉瘤2例,Enneking分期均为ⅡB期.所有患儿均术前穿刺活检以明确诊断,并接受规范的新辅助化疗.结果 22例患儿均获得随访,生存患儿平均随访37.63(24～86)个月,局部复发率为4.55%(1/22),肺转移发生率为18.18%(4/22),1例死于术后化疗并发症.术后14例患儿共延长34次,每次延长约1cm,得以延长的患儿双下肢基本等长,长度差平均为0.4(0～1.0)cm.参照国际骨与软组织肿瘤协会(MSTS)功能评估标准,最终MSTS评分平均为76.67%(23/30).配对t检验显示延长组患儿延长前后患肢功能差异无统计学意义.术后假体相关并发症:假体周围感染1例,膝关节倾斜、假体松动下沉和皮下感染各1例.结论 在儿童保肢手术中应用可延长假体的初步结果显示,其既能重建广泛切除肿瘤后的骨缺损,又能解决切除儿童骨骺引发的肢体不等长,具有良好的临床应用前景.

Limb salvage surgery with the expandable prosthesis in skeletally immature children with malignant bone tumors

Objective To evaluate the effect of expandable prostheses in skeletally immature chil-dren with malignant bone tumor after limb salvage surgery.Methods From January 2002 to December2007,clinical records of the musculoskeletal oncology department of the first affiliated hospital were re-viewed retrospectively.A total of 22 children who underwent limb salvage with the expandable prostheses were registered and included in the study.There were 20 cases with osteosarcoma and two cases with Ewing sarcoma.There were eleven males and eleven females.The patients ranged from 6 to 13 years old,with an average age of 10.7 years.The tumor was located in the distal femur in eighteen cases,in the proximal tibiae in three and in the proximal femur in one case.All patients were confirmed by preoperative needle biopsy and defined as stage ⅡB according to Enneking classification.The standardized neo-adjuvant chemotherapy was routinely performed in all patients.Results The follow-up time ranged from 24 to 86 months,with the mean of 37.63 months.One patient underwent local recurrence(4.55%).The rate of lung metastasis was18.18%(4 in 22).One patient died of complication caused by postoperative chemotherapy.Fourteen cases had undergone limb-lengthening for 34 times and achieved equal lower extremities finally.The average limb-length discrepancy was 0.4 cm after lengthening(range,0 to 1).According to Musculoskeletal Tumor Society(MSTS)functional More rating system,the mean score was 76.67%(23/30).There was no difference in the functional score between before and after the limb lengthening surgery.There were four complications related to prostheses including peri-prosthesis infection,the oblique of the knee surface,prosthesis subsidence,asep-tic loosening,and subcutaneous infection.Conclusion The expandable prostheses can not only reconstruct the bone defect after wide resection,but also offer good functional outcome.Longer follow-up is needed to confirm the promising results.