骨延长术治疗股骨远端骨肉瘤患儿保肢术后重度肢体不等长的教训与体会  

Bone lengthening surgery for the treatment of children with osteosarcoma in the distal femur with severe limb-length discrepancy after different limb salvage surgeries:lessons learned and experiences

作　　者：崔浩诚 郑凯 徐明 于秀淳 CUI Hao-cheng;ZHENG Kai;XU Ming;YU Xiu-chun(Orthopedic Department,960 Hospital of People’s Liberation Army,Jinan,Shandong,250031,China)

机构地区：[1]中国人民解放军联勤保障部队第九六〇医院骨科,济南250031

出　　处：《中国骨与关节杂志》2024年第5期342-349,共8页Chinese Journal of Bone and Joint

摘　　要：目的通过介绍骨延长术治疗儿童股骨远端骨肉瘤不同保肢手术后发生重度肢体不等长患儿的治疗过程,探讨不同保肢手术对骨延长治疗的影响,总结经验教训。方法回顾报道3例儿童股骨远端骨肉瘤患儿,男2例女1例,行初次保肢手术时的年龄分别为8岁、8岁、12岁,2例患儿采用股骨远端肿瘤切除保留股骨远端骨骺的同种异体骨重建,1例患儿采用股骨远端肿瘤切除保留胫骨近端骨骺的铰链型膝关节假体置换。术后长期随访,随访时间均>6年,3例患儿骨骺闭合后均出现了重度的双下肢不等长,通过骨延长术进行了短缩肢体的延长。结果2例采用同种异体骨保肢的患儿,利用单臂外固定支架进行了股骨近端的骨延长手术,延长过程顺利,延长术后肢体等长。1例采用铰链型膝关节假体置换的患儿,术后6年出现了假体松动及股骨、胫骨的短缩,取出松动的假体后安放占位器,利用单臂外固定支架进行了股骨近段的骨延长,延长过程中出现了钉道及深部组织的反复感染,股骨延长满意后进行了膝关节融合。融合后再次通过Ilizarov环形支架进行了胫骨的延长,最终达到了双下肢的等长。结论对于骨骺未闭的儿童股骨远端骨肉瘤患儿,生物重建和假体重建均会导致骨骺闭合后的双下肢不等长。但采用生物重建技术,可以不影响胫骨近端骨骺的生长潜力,而且还为将来进行股骨延长留有充分的治疗余地。Objective By introducing the treatment process of bone lengthening surgery for severe limblength discrepancy(LLD)in children with osteosarcoma of the distal femur after different limb salvage surgeries,this study explores the impact of different limb salvage surgeries on bone lengthening treatment,and summarizes experience and lessons learned.Methods A retrospective analysis was conducted on three children with osteosarcoma of the distal femur,two males and one female.They underwent initial limb salvage surgery at the age of 8,8,and 12,respectively.Two patients underwent allogeneic bone reconstruction with distal femoral tumor resection and preservation of the distal femoral epiphysis,while one patient underwent distal femoral tumor resection and reconstruction with a special hinged knee prosthesis which preserved proximal tibial epiphyseal.Long term follow-up after surgery,with follow-up time longer than 6 years,showed severe limb-length discrepancy in all 3 patients after epiphyseal closure.Bone lengthening surgery was performed to lengthen the lower limbs.Results Two patients who had reconstruction with allogeneic bone underwent bone lengthening surgery at the proximal end of the femur using a single arm external fixation bracket.The lengthening process was smooth,and the length of lower limbs was equal after the lengthening surgery.The patient who underwent hinged prosthesis replacement experienced loosening of the prosthesis and shortening of the femur and tibia 6 years after surgery.After removal of the loose prosthesis,a cement spacer was placed and a single arm external fixation bracket was used to lengthen the proximal femur bone.During the lengthening process,repeated infection of the pin site and deep tissue occurred.After satisfactory femoral lengthening,knee joint fusion was performed.The tibia was lengthened again using the Ilizarov circular stent after fusion,ultimately achieving equal length for lower limbs.Conclusions For distal femur osteosarcoma children with unclosed epiphyses,both biological

关 键 词：骨延长术 儿童 骨肉瘤 下肢不等长 保肢术 

分 类 号：R738.1[医药卫生—肿瘤]