摘要
目的评估使用肿瘤型人工膝关节置换治疗儿童股骨远端骨肉瘤的治疗效果。方法2003年12月至2008年12月,36例14岁以下股骨远端骨肉瘤儿童患者行肿瘤型人工膝关节置换手术,31例随访数据完整。患者年龄9～14岁,平均12.3±1.6岁。男11例,女20例。所有患者都是未经治疗的IIB期原发骨肉瘤。所有患者都经过标准术前化疗、肿瘤型人工膝关节置换手术及术后化疗。结果手术使用普通单纯铰链式膝关节8例,普通旋转铰链式膝关节11例,特制远端非水泥固定铰链式膝关节12例。边缘切除9例,广泛切除22例。31例患者随访12～75个月,中位随访时间26个月,平均32个月。随访期间死亡13例,存活18例,无瘤生存16例,带瘤生存2例。Kaplan-Meier生存分析显示2年生存率74.1%,3年生存率44.6%。局部复发2例(6.5%)。转移14例(45.2%),其中肺转移10例(32.3%),软组织或骨转移3例(9.7%),肺转移合并软组织转移或骨转移1例(3.2%)。存活且未截肢患者15例,MSTS功能评分平均21.5±4.7分,肢体功能优良率86.7%。三种假体术后功能比较,差异无显著性(P=0.979)。随访期内假体并发症发生率38.7%,其中假体周围感染2例(6.5%),假体松动10例(32.3%)。特制远端非水泥固定铰链式关节并发症低于常规使用关节。结论在标准治疗后,肺转移是导致儿童骨肉瘤患者死亡的主要原因;外科边界与局部复发关系密切,提高保肢的安全性需恰当地选择外科边界;特制远端非水泥固定铰链式人工假体与常规使用人工假体功能无明显差异,并不增加早期并发症发生率。
Objective To evaluate the effect of endoprosthetic replacement after resection of osteosarcoma at distal femur of children. Methods 36 children aged under 14 underwent endoprosthetic replacement after resection of osteosarcoma at distal femur between Dec 2003 to Dec 2008 in our center. 31 children＇s data were complete. Their average age was 12.3±1.6, ranging from 9 to 14. There were 11 boys and 20.girls. All the patients sustained primary osteosarcoma in stage liB without treatment in other hospital, and have undergone standard preoperative chemotherapy, endoprosthetic replacement and post-operative chemotherapy. Results 8 patients were reconstructed with hinge knee prostheses and 11 with rotational hinge knee prostheses. 12 patients were reconstructed with special hinge knee prostheses which was fixed without cement in tibial component. 9 patients underwent marginal resection and 22 underwent wide resection. 31 patients were followed up for 12 to 75 months. The median follow-up was 26 months. At the end of follow-up, 13 patients died and 18 survivied. 16 survived tumor-free and 2 survived with tumor. The 2-year survival rate was 74.1% and the 3-year survival rate was 44.6% shown by the Kaplan-Meier analysis. 2 patients had local recurrence （6.5%）. 14 had metastases, 10 in the lungs, 3 in soft tissues, and 1 had combined metastases in the lungs and the soft tissues or the bones. 15 patients survived without amputation. The mean MSTS function score was 21.5±4.7. The excellent-good rate of limb fimction was 86.7%. The three prostheses were compared and the difference was not significant（P=0.979）. The complication rate of prostheses was 38.7%, including peri-prosthesis infection in 2 patients（6.5%） and loosening of prostheses in 10 patients （32.3%）. The special hinge knee prostheses with cementless fixation in tibial component was found to cause lower complications rate than conventional tumor knee prostheses. Conclusions After standard therapy, lung metastasis is the major cause of death. The local recurrence rate was closely related to the surgical margin. Adequate surgical margin can increase safety of limb salvage surgery. The difference between the special hinge knee prostheses and conventional tumor knee prostheses is not significant. The early complication rate is not increased in special hinge knee prostheses group.
出处
《中国骨肿瘤骨病》
2010年第2期116-121,共6页
Chinse Journal Of Bone Tumor And Bone Disease
关键词
骨肉瘤
人工关节
重建
综合治疗
Osteosarcoma
Endoprosthetic replacement
Reconstruction
Combined therapy
