摘要
目的探讨人工半膝关节假体重建小儿骨肉瘤切除术后骨缺损的疗效。方法回顾分析2016年1月—2019年12月收治且符合选择标准的18例骨肉瘤患儿临床资料。其中男11例,女7例;年龄6~10岁,平均8.9岁。骨肉瘤位于股骨下段11例,胫骨上段7例。普通型骨肉瘤12例,小细胞骨肉瘤6例。病程1~9个月,平均3.1个月。术前经2周期多柔比星+顺铂+异环磷酰胺化疗。均行瘤段切除后采用定制人工半膝关节假体重建骨缺损。术后8周开始在膝关节限制支具保护下进行康复训练,术后4周期辅助化疗。术后测量患儿下肢生长长度、肢体短缩长度(与健侧肢体相比);采用美国肌肉骨骼肿瘤学会评分系统(MSTS-93)评分评估患肢功能。结果所有患儿均顺利完成手术,手术时间2.0~3.1 h,平均2.4 h;术中出血量180~320 mL,平均230.0 mL。术后10 d出现切口边缘坏死1例,其余患儿切口均Ⅰ期愈合。1例术后1周发生金黄色葡萄球菌引起假体周围感染,经对症处理后治愈。18例患儿均获随访,随访时间60~96个月,平均74.2个月。随访期间未见肿瘤局部复发;影像学检查示2例发生假体松动,其余患儿假体位置良好。末次随访时,膝关节活动度为80°~120°,平均106.7°。MSTS-93评分16~29分,平均24.7分,获优12例、良5例、中1例。患儿身高增加12.8~20.0 cm,平均15.5 cm;下肢生长长度6.0~13.0 cm,平均9.7 cm;肢体短缩长度1.8~4.6 cm,平均3.1 cm。股骨下段组和胫骨上段组MSTS-93评分及下肢生长长度、肢体短缩长度比较差异均无统计学意义(P>0.05)。结论人工半膝关节假体重建可保留膝关节相邻的正常骨骺、最大限度保留肢体生长潜力、减少成年后肢体不等长问题,对膝关节骨肉瘤患儿是一个合适的重建方案。
Objective To explore the effectiveness of artificial hemi-knee prosthesis reconstruction for bone defects after resection of pediatric osteosarcoma.Methods A retrospective analysis was conducted on the clinical data of 18 children with osteosarcoma who met the selection criteria and were treated between January 2016 and December 2019.There were 11 males and 7 females,aged 6-10 years(mean,8.9 years).Osteosarcoma located in the distal femur in 11 cases and the proximal tibia in 7 cases.Among them,12 cases were conventional osteosarcoma and 6 cases were small cell osteosarcoma,with a disease duration of 1-9 months(mean,3.1 months).All patients received 2 cycles of preoperative chemotherapy with doxorubicin,cisplatin,and ifosfamide.After en bloc tumor segment resection,bone defects were reconstructed using custom-made artificial hemi-knee prostheses.Rehabilitation training was initiated at 8 weeks postoperatively under the protection of a knee immobilizer brace,combined with 4 cycles of adjuvant chemotherapy.During follow-up,lower limb growth length and limb shortening(compared with the healthy side)were measured,and limb function was evaluated using the Musculoskeletal Tumor Society-93 (MSTS-93) scoring system. Results Allsurgeries were successfully completed, with an operation time of 2.0-3.1 hours (mean, 2.4 hours) and intraoperative bloodloss of 180-320 mL (mean, 230.0 mL). Incisional edge necrosis occurred in 1 case at 10 days postoperatively, while theincisions of the remaining 17 patients healed by first intention. One case developed periprosthetic infection caused byStaphylococcus aureus at 1 week postoperatively, which was cured after symptomatic treatment. All 18 patients werefollowed up 60-96 months (mean, 74.2 months). No local tumor recurrence was observed during follow-up. Imagingexaminations showed prosthesis loosening in 2 cases, while the prosthesis of other patients were well-positioned. At lastfollow-up, the knee joint range of motion was 80°-120° (mean, 106.7°). The MSTS-93 score was 16-29 (mean, 24.7), with12 cases rated as excellent, 5 good, and 1 fair. The patients’ height increased by 12.8-20.0 cm (mean, 15.5 cm), the lowerlimb growth length was 6.0-13.0 cm (mean, 9.7 cm), and limb shortening was 1.8-4.6 cm (mean, 3.1 cm). There was nosignificant difference in MSTS-93 scores, lower limb growth length, or limb shortening between the distal femur groupand the proximal tibia group (P>0.05). Conclusion Artificial hemi-knee prosthesis reconstruction can preserve theadjacent normal epiphysis of the knee joint, maximize limb growth potential, and reduce adult limb length discrepancy,making it a suitable reconstruction option for children with knee osteosarcoma.
作者
沈荣凯
陈勐
陈飞
宋耀光
朱夏
SHEN Rongkai;CHEN Meng;CHEN Fei;SONG Yaoguang;ZHU Xia(Department of Bone Oncology,the First Affiliated Hospital of Fujian Medical University,Fuzhou Fujian,350004,P.R.China;Department of Orthopedics,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University,Fuzhou Fujian,350004,P.R.China)
出处
《中国修复重建外科杂志》
北大核心
2025年第7期824-830,共7页
Chinese Journal of Reparative and Reconstructive Surgery
基金
福建省科技创新联合基金项目(2021Y9095)
福建省财政专项(BPB-2022SRK)
福建省卫生健康委员会医学创新课题(2022CXA022)。
关键词
骨肉瘤
人工半膝关节假体
保肢手术
肢体不等长
Osteosarcoma
artificial semi-knee prosthesis
limb salvage surgery
limb length discrepancy
