儿童膝关节周围骨肉瘤保留骨骺生物重建的近期随访  

Recent Follow-up of Biological Reconstruction of Epiphysis Preserving Osteosarcoma Around the Knee in Children

作　　者：戴志兵[1] 孙亚超[1] 麦尔旦江·麦合木提 江仁兵[1] Dai zhibing;Sun Yachao;Maierdanjiang·Maihemuti;Jiang Renbing(Department of bone and soft tissue,Affiliated Tumor Hospital of Xinjiang Medical University,Urumqi 830000,China)

机构地区：[1]新疆医科大学附属肿瘤医院骨与软组织科,新疆乌鲁木齐830000

出　　处：《实用骨科杂志》2022年第6期503-508,共6页Journal of Practical Orthopaedics

摘　　要：目的评估5例儿童膝关节周围骨肉瘤保留骨骺生物重建的疗效。方法回顾2019年1月至2020年9月在新疆医科大学附属肿瘤医院骨与软组织科行膝关节周围骨肉瘤保留骨骺生物重建的5例患者资料,男3例,女2例;年龄8~14岁,平均(11.6±2.6)岁;2例股骨骨肉瘤,3例胫骨骨肉瘤;肿瘤切除后骨缺损12~30 cm,平均(18.0±6.9)cm。重建方式:2例股骨骨肉瘤采用自体骨液氮灭活再植+同侧带血管腓骨移植;2例胫骨骨肉瘤采用自体骨液氮灭活再植+同侧带血管腓骨移植;1例胫骨骨肉瘤采用自体骨液氮灭活再植+对侧带血管腓骨移植。定期复查X线片了解骨愈合情况,末次随访评估下肢长度及膝关节屈伸功能。结果随访15~36个月,所有病例均达到骨愈合,骨愈合时间为(5.2±1.9)个月(3~8个月)。末次随访2例双下肢等长,2例患肢短缩≤1 cm,1例患肢短缩2 cm。4例膝关节屈曲>90°,1例屈曲50°~60°,未见肿瘤复发及远处转移。肌肉骨骼肿瘤学会(muscle skeletal tumor society,MSTS)评分为(24.2±2.5)分(20~26分)。结论儿童膝关节周围骨肉瘤行保留骨骺的自体骨液氮灭活再植结合带血管腓骨复合重建有利于骨愈合,有利于肢体长度的保持和术后功能恢复,近期效果良好。Objective To evaluate the effectiveness of biological reconstruction in five children of periarticular osteosarcoma of the knee.Methods Five patients with osteosarcoma around knee joint undergoing epiphyseal preserving biological reconstruction in Department of Bone and Soft Tissue of Affiliated Tumor Hospital of Xinjiang Medical University from January 2019 to September 2020 were selected retrospectively.The patents aged(11.6±2.6)years(8~14 years),including two femurs and three tibias.The length of bone defect was(18.0±6.9)cm(range 12~30 cm).Two femur tumors were treated with inactivated autologous bone by liquid nitrogen with vascularized fibula transplantation.Two tibia tumors were treated with inactivation autologous bone by liquid nitrogen with ipsilateral vascularized fibula transplantation.One tibia tumor was treated with inactivation autologous bone by liquid nitrogen with contralateral vascularized fibula transplantation.Patients regularly underwent X-rays exam to determine the bone healing.Lower limb length and knee flexion and extension function were evaluated at the end of follow-up.Results The patients were followed up for 15~36 months.All cases achieved bone healing,and bone healing time was(5.2±1.9)months(3~8 months).Two patients had equal length of limbs,two patients had limb shortening less or equal to 1 cm,and one case had shortening of 2cm.The knee flexion was more than 90°in four patients and 50°~60°in one patient.No tumor recurrence and distant metastasis.The muscle and skeletal tumor society(MSTS)score was(24.2±2.5)score(range 20~26 score).Conclusion Autogenous bone inactivation by liquid nitrogen with epiphyseal preservation combined with vascularized fibula in reconstruction for osteosarcoma around the knee in children is good to bone healing,limb length maintenance and postoperative functional recovery.The short-term effect is satisfactory.

关 键 词：骨肉瘤 骨骺 自体骨液氮灭活 带血管蒂腓骨 生物重建 

分 类 号：R738.1[医药卫生—肿瘤]