定制型人工膝关节置换治疗儿童膝关节周围骨肉瘤  

Custom-made rotating hinge artificial replacement for osteosarcoma around knee joint in children

作　　者：李甲振[1] 张岩[1] 张怀栓[2] 石海龙[2] 张鹏飞[3] 刘源[4] 闻嘉[1] 

机构地区：[1]郑州大学第一附属医院骨科,450052 [2]郑州市骨科医院 [3]郑州大学第五附属医院骨科 [4]安阳地区医院

出　　处：《中华小儿外科杂志》2015年第5期326-330,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的分析使用定制型人工膝关节假体置换治疗儿童膝关节周围骨肉瘤的治疗效果。方法对2005年12月至2010年12月行肿瘤型人工膝关节假体置换术的23例15岁以下膝关节周围骨肉瘤患儿进行回顾性分析，男11例，女12例，年龄8～15岁，平均11．3岁。所有患儿均为首诊原发骨肉瘤，瘤灶位于股骨远端14例，胫骨近端9例，均为EnnekingUA期。手术使用普通旋转铰链式膝关节假体置换14例，普通可调旋转铰链式膝关节假体置换9例。采用MSTS93保肢评分系统分析治疗结果。缩果23例患儿随访12～72个月，平均36个月。随访期间死亡10例，存活13例，术后2年生存率78．2％（18／23），3年生存率65．2％（15／23），局部复发2例（8．7％），转移11例（47．8%），其中肺转移8例（34．8％），软组织或骨转移3例（13．0%）。术后MSTS93功能评分平均（22．3±4．5）分，Enneking肢体功能评估优良率82．6％。两种假体术后功能比较，差异无统计学意义（P〉0-05）。随访期内假体并发症发生率38．1％，其中假体周围感染1例（4．3％），假体松动2例（8．7%），假体脱位1例（4．3％）。结论定制型人工膝关节置换应用于儿童膝关节周围骨肉瘤的治疗具有可行性并保留了儿童患肢功能，患儿更易接受；肺转移是导致儿童骨肉瘤患儿死亡的主要原因。Objective To evaluate the therapeutic efficacies of custom-made rotating hinge artificial total knee replacement after resecting osteosarcoma around knee in children. Methods A total of 23 children aged from 8-15 years underwent custom-made rotating hinge artificial total knee replacement after resecting osteosarcoma around knee joint between December 2005 to December 2010. There were 11 boys and 12 girls with an average age of （11.3 ± 2. 6） years. Imaging study showed that tumors were located at distal femur （n = 14） and proximal tibia （n = 9）. The diagnosis of primary osteosarcoma was confirmed by pathological examination. All were graded as stage IIA according to Eneeking staging system. No treatment was offered at other hospitals. Preoperative chemotherapy, custom-made rotating hinge artificial replacement and postoperative chemotherapy were offered. The clinical data were complete for 23 children. And 14 patients had a reconstruction of rotational hinge knee prostheses while the remainder special rotational adjustable hinge knee prostheses. Results The average follow up period was 36 （12-72） months. Ten patients died and 13 survived at the end of follow-up. The 2 and 3-year survival rates were 78. 2% （n = 18） and 65.2% （n = 15） respectively. Two patients had local recurrence （8. 7%）. There were metastases in lungs （n = 8） and soft tissues or hones （n = 3）. The mean Musculoskeletal Tumor Society （MSTS） function score was 22. 3 ± 4. 5. The excellent-good rate of extremity function was 82. 6% according to the Eneeking staging system. The difference of two prostheses was insignificant （P〉0. 05）. The complication rate of prostheses was 38. 1%, including peri-prosthesis infection （n = 1, 4. 3%）, loosening of prostheses （n = 2, 8. 7%） and prosthetic dislocation （n = 1, 4. 3% ）. Conclusions Custom-made rotating hinge artificial replacement for osteosarcoma around knee joint in children can significantly improve the survival andpreserve extremity function. L

关 键 词：骨肉瘤 儿童 人工关节 骨重建 

分 类 号：R738.1[医药卫生—肿瘤]