半关节置换术在小儿胫骨上段恶性骨肿瘤中的应用  

SEMI-JOINT PROSTHESIS REPLACEMENT IN TREATMENT OF MALIGNANT TUMORS AROUND CHILDREN'S KNEES

作　　者：伍骥[1] 朱克顺[1] 潘庆联[2] 

机构地区：[1]空军总医院骨科,北京100036 [2]空军总医院神经内科,北京100036

出　　处：《中国修复重建外科杂志》2006年第10期978-980,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨半关节置换术用于儿童膝关节恶性骨肿瘤，以保留膝关节或重建膝天节的疗效。方法2000年3月～2005年6月对5例胫骨上段骨肉瘤患儿行半膝关节假体置换，年龄8～12岁。均经病理确诊为胫骨上段骨肉瘤，Enneking分期为ⅡB期以下。病变范围9～11cm，术前均行穿刺活检和正规化疗，并根据x线片、CT、MRI等影像学结果确定病变范围，测量和设计假体大小，假体长度略长于截骨段1～2cm。术后4周在支具保护下行走，并行2个疗程新辅助化疗。结果5例患儿均成功进行了半膝关节假体置换，术后4周膝关节活动度分别为伸170～180°，屈90～120°。术后除1例局部皮肤坏死，经皮瓣移位修复伤口Ⅱ期愈合外，余患儿伤口均1期愈合。随访24～36个月，1例于术后8个月因肿瘤肺转移死亡，余均无肿瘤转移和复发，均能进行日常生活和学习。结论半膝关节置换用于儿童膝关节周围恶性肿瘤，具有保留正常骨骺及膝关节和重建膝关节优点，同时达到保肢手术的目的，为成年后全膝关节置换创造了条件。Objective To investigate the effect of the semi-joint prosthesis replacement in treating malignant tumors around the children＇s knees. Methods Five children （aged 8-12 years） with malignant tumors around the proximal end of the tibia underwent the semi joint prostheses replacement from March 2000 to June 2005. All the children had been diagnosed with osteosarcoma, which was graded as Ⅱ B by the Enneking staging system. The pathologic changes involved the upper segment of the tibia 9-11 cm in length. Before operation all the patients underwent puncture biopsy and standard chemotherapy. The lesion extent was determined byX ray, CT and MRI, and then the size of the prosthesis was determined. The length of the prosthesis was 1-2 cm longer than that of the excised bone. After operation the patients were givenneoadjuvant chemotherapy for 2courses and they could walk with the help of a special brace 4 weeks postoperatively. Results All the 5 patients had a successful semi joint prosthesis replacement except one patient who had a skin flap necrosis, and the wound healed after a flap grafting. The remaining patients had their wounds healed by first intention. The 12-36 months＇ follow-up revealed that all the patients had no metastasis or recurrence of the tumor and they were living and well except one patient who died of lung metastasis 8 months after operation. Conclusion The semi-joint prosthesis replacement in the limb salvage surgery for maligant tumors around the children＇s knees has advantages of avoiding a damage to the normal osteoepiphysis, stabilizing the knee joint, and facilitating elongation of the limb in future. It also creates the condition for total knee replacement in adults.

关 键 词：儿童 恶性骨肿瘤 半关节假体置换 保肢 

分 类 号：R738[医药卫生—肿瘤]