摘要
目的探讨一期胫骨近端半关节置换联合二期假体翻修对减少儿童胫骨近端骨肉瘤肢体不等长的可行性及疗效。方法 2009年—2013年,收治3例儿童胫骨近端经典型骨肉瘤(ⅡB期)患者。男2例、女1例;年龄分别为12、13、13岁。术前化疗4个疗程后,一期行胫骨近端瘤段切除、胫骨近端半关节置换术;待患者20、17、17岁时行二期假体翻修术。结果 3例患者均顺利完成两期手术。二期术后双下肢长度相差19、7、21 mm。二期术后分别随访13、3、27个月,患者下肢功能恢复满意,根据美国骨与软组织肿瘤协会功能评分标准(MSTS)评分分别为26、27、25分。结论一期胫骨近端半关节置换联合二期翻修手术治疗儿童胫骨近端骨肉瘤,可保留股骨远端生长能力,减少双下肢不等长程度,并获得满意稳定性和良好功能。
Objective To investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma. Methods Between 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia(stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively. Results All patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively.Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society(MSTS) score was 26, 27, and 25, respectively. Conclusion The proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.
引文
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