经“Y”型软骨截骨髋臼挽救术治疗儿童和青少年TypeII型骨盆尤文肉瘤  

Acetabulum salvage by osteotomy through triradiate cartilage for surgical management of type II pelvic Ewing sarcomain children and adolescents

作　　者：范宏斌[1] 王臻[1] 郭征[1] 付军[1] 吴志钢[1] 陈国景[1] 栗向东[1] 李靖[1] 

机构地区：[1]第四军医大学附属西京医院骨与软组织肿瘤科,西安710032

出　　处：《中华骨科杂志》2014年第4期460-465,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨采用经“Y”型软骨截骨髋臼挽救术治疗儿童和青少年TypeⅡ型骨盆尤文肉瘤患者的生存率及疗效。方法回顾性分析2001年1月至2010年10月采用经髋臼“Y”型软骨截骨、异体髋臼复合钢板重建、髋臼挽救术治疗8例骨盆Typell型尤文肉瘤患者资料，男6例，女2例；手术时年龄7-16岁，平均12．7岁。其中3例肿瘤位于“Y”型软骨上方，4例位于“Y”型软骨前下方，1例位于“Y”型软骨后下方；均为局部肿瘤，无远处转移。所有患者均行x线、CT、MRI等影像学检查，并经病理学诊断证实。化疗采用顺铂（CDP）、阿霉素（ADM）和异环磷酰胺（IFO）方案。所有患者术前均接受一个循环的新辅助化疗（即IFO-ADM＋CDP-IFO），术后均接受三个循环的IFO-ADM＋CDP-IFO和局部放疗；放射治疗覆盖时间内的化学治疗同期进行。3例采用传统切除重建手术，5例借助于计算机辅助导航系统接受了肿瘤的精确切除和重建手术。结果依据实体瘤疗效评价标准对新辅助化疗进行评价，结果显示1例为完全响应，6例为部分响应，1例为痈隋平稳。无一例患者被诊断为疾病进展。术后8例患者均获得随访，随访时间为12-72个月，中位随访时间为37．8个月。7例患者无瘤生存时间为24-60个月，平均39个月。术后24个月1例患者死于肿瘤转移。两年生存率为100％，五年生存率为87．5％（7／8）。肌肉骨骼肿瘤协会（MsTs）评分为18-27分，平均25_4分。国际保肢协会影像学评分为76％-94％，平均90．1％。结论采用经髋臼“Y”型软骨截骨、异体髋臼复合钢板重建、髋臼挽救术治疗儿童和青少年TypeⅡ型骨盆尤文肉瘤，术后患者生存率高，可恢复患者的肢体功能。“Y”型软骨有可能是抵御肿瘤侵袭的天然屏障。Objective To analyze the survival rate and functional outcomes after osteotomy through acetabular triradiate cartilage for surgical management of type Ⅱ pelvic Ewing sarcoma. Methods Data of 8 patients （male： 6; female： 2） with type Ⅱ pelvic Ewing sarcoma receiving treatment in our department from January 200l to October 2010 were retrospectively analyzed. The mean age was 12.7 years （range, 7-16 years）. The tumors were located above, anteiro-inferior, and posterior-inferior to triradi-ate cartilage in 3, 4, and 1 case, respectively. All tumors were localized and no metastasis was found. All patients received X-ray film, CT scan, and MRI. The diagnosis was determined by biopsy. All patients had undergone neoadjuvant chemotherapy and ra- diotherapy （post operation）. All patients received 1 cycle of IFO-ADM＋CDP-IFO and 2 cycles of same reagents before and after surgery. All patients received radio-therapy after surgery. In these consecutive patients, three received conventional surgery and another 5 were operated with the help of computer-assisted surgical navigation system. Results According to response evalua-tiong criteria in solid tumors （RECIST）, CR was in 1 case, PR in 6 cases and SD in 1 case. No patient was recorded as PD. All pa-tients were followed up for 12 to 72 months （mean, 37.8 months）. There were 7 patients surviving from 24 to 60 months （mean, 39 months） with disease-free survival. One patient died of metastasis at 24 months postoperatively. The cumulative survival rate at 2 and 5 years were 100% and 87.5%, respectively. The MSTS score ranged from 18 to 27 （mean, 25.4） and radiological score of In- ternational Society of Limb Salvage （ISOLS） ranged from 76% to 94% （mean, 90.1%）. Conclusion Osteotomy through acetabular triradiate cartilage in combination with allograft reconstruction can maximally restore the hip function and increase the survival rate. The triradiate cartilage may be a natural barrier to orevent tumor invasion.

关 键 词：髋臼 骨盆 肉瘤 EWING 截骨术 青少年 

分 类 号：R738.1[医药卫生—肿瘤]