灭活骨重建治疗胫骨远端骨肉瘤的临床应用  

Reconstruction strategy with recycled bone for distal tibial osteosarcoma

作　　者：沈嘉康[1] 蔡郑东[1] 华莹奇[1] 孙梦熊[1] 左冬青 汪红胜 昝鹏飞 孙伟[1] Shen Jiakang;Cai Zhengdong;Hua Yingqi;Sun Mengxiong;Zuo Dongqing;Wang Hongsheng;Zan Pengfei;Sun Wei(Department of Orthopedic Oncology,Shanghai General Hospital,Shanghai 200080,China)

机构地区：[1]上海市第一人民医院骨肿瘤科,200080

出　　处：《中华骨科杂志》2021年第16期1108-1115,共8页Chinese Journal of Orthopaedics

摘　　要：目的探讨利用自体骨灭活后回植重建踝关节治疗胫骨远端骨肉瘤的可行性及治疗结果。方法回顾性收集2018年6月至2019年4月6例胫骨远端骨肉瘤患者资料,男4例,女2例;年龄(16.8±4.4)岁(范围10~22岁)。6例均经穿刺活检确诊为骨肉瘤,EnneckingⅡa期4例,Ⅱb期2例;术前接受4个疗程新辅助化疗。行瘤段切除,肿瘤骨灭活后回植内固定重建术,术中瘤段被完整切除,将骨段巴氏消毒法进行灭活,即65℃下质量浓度为10%的氯化钠溶液中浸泡45 min;取出后在瘤段骨缺损处填充骨水泥,并安置钢板螺钉和锚钉等内固定材料;最后回植灭活骨内固定复合体(auto-graft-fixation composite,AFC),重建软组织。术后石膏固定3月后接受康复治疗;术后2周开始继续接受化疗。术后3、6、12个月随访摄胫骨下段正侧位X线片,评估骨愈合率和骨愈合时间;评价瘤段截骨长度、手术时间、术中出血、视觉模拟评分(visual analogue scale,VAS)、世界骨与软组织肿瘤协会评分(Musculoskeletal Tumor Society,MSTS)评分、美国足踝外科协会评分(American Orthopaedic Foot&Ankle Society,AOFAS)评估踝关节功能;同时统计肿瘤学结果。结果6例均顺利完成手术,均获得随访,随访时间(20±5)个月(范围12~28个月),无一例发生深部感染、内固定机械性失败或肿瘤局部复发等并发症。至末次随访,6例的MSTS评分为(26.7±2.6)分;AOFAS为(82.3±8.5)分;VAS评分为(2.7±1.3)分。3例在术后发生伤口皮肤局部溃疡,换药后愈合;5例在随访期间可观察到形成骨痂愈合。所有病例均对治疗结果满意。结论采用肿瘤骨灭活回植内固定重建踝关节后不但能根治肿瘤,而且具有满意的肢体功能,是较理想的保肢重建策略。Objective Limb salvage treatment for osteosarcoma in the distal tibiais challenging and the incidence of postoperative complications is high.To prove that the use of autologous bone inactivation to replant the ankle joint has a satisfactory clinical effect.Methods This study retrospectively studied 6 cases(4 males and 2 females)of the osteosarcoma of the distal tibia from June 2018 to April 2019 in our center.The average case age was 16.8 years.All cases were first diagnosed in the center,and classic osteosarcoma was confirmed by biopsy.Before the operation,he received 4 courses of neoadjuvant chemotherapy.The tumor was resected under general anesthesia,and the tumor bone was inactivated and replanted for internal fixation and reconstruction.During the operation,the tumor segment was completely removed,and after a series of treatments,it was immersed in hypertonic saline at 65℃ for 45 min.After removal,the bone defect was filled with bone cement,and internal fixation materials such as plate screws and anchors were placed.Finally,soft tissue was rebuilt after the inactivated bone internal fixation complex(autograft-fixation composite,AFC)was replanted.Patients were treated with plaster for 3 months after surgery.Chemotherapy continued 2 weeks after surgery.Follow-up X-ray of the lower tibia were taken at 3 months,6 months,and 12 months after the operation to evaluate the MSTS score and ankle function score(AOFAS)to evaluate the ankle function.Results The patients were followed up for an average of 20 months.At 12 months after operation,no complications such as deep infection,mechanical failure of internal fixation,or local tumor recurrence occurred.The MSTS score averaged 26.7±2.6 points.The AOFAS average was 82.3±8.5 points.The VAS average is 2.7 points.Boneunionwasobserved in 5 cases during follow-up.All cases were satisfied with the treatment results.Conclusion Limb salvage treatment of distal tibia osteosarcoma is more difficult.This study proves that the use of tumor bone inactivation and internal fixatio

关 键 词：骨肉瘤 胫骨远端 骨重建 内固定器 治疗结果 

分 类 号：R738.1[医药卫生—肿瘤]