一期胫骨近端半关节置换联合二期翻修治疗三例儿童胫骨近端骨肉瘤
|
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.
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
1 Niu X, Xu H, Inwards CY, et al. Primary bone tumors:epidemiologic comparison of 9200 patients treated at Beijing Ji Shui Tan Hospital, Beijing, China, with 10 165 patients at Mayo Clinic, Rochester, Minnesota. Arch Pathol Lab Med, 2015, 139(9):1149-1155.
2 Daw NC, Neel MD, Rao BN, et al. Frontline treatment of localized osteosarcoma without methotrexate:results of the St. Jude Children's Research Hospital OS99 trial. Cancer, 2011, 117(12):2770-2778.
3 Zhang C, Hu J, Zhu K, et al. Survival, complications and functional outcomes of cemented megapr os theses for high-grade osteosarcoma around the knee. Int Orthop, 2018,42(4):927-938.
4 Mavrogenis AF, Pala E, Angelini A, et al. Proximal tibial resections and reconstructions:clinical outcome of 225 patients. J Surg Oncol,2013,107(4):335-342.
5 Nystrom LM, Morcuende JA. Expanding endoprosthesis for pediatric musculoskeletal malignancy:current concepts and results. Iowa Orthop J, 2010, 30:141-149.
6 Decilveo AP, Szczech BW, Topfer J, at al. Reconstruction using expandable endoprostheses for skeletally immature patients with sarcoma. Orthopedics, 2017,40(1):e157-e163.
7 Eckardt JJ, Kabo JM, Kelley CM, et al. Expandable endoprosthesisreconstruction in skeletally immature patients with tumors. Clin Orthop Relat Res, 2000,(373):51-61.
8 Benevenia J, Patterson F, Beebe K, et al. Results of 20 consecutive patients treated with the Repiphysis expandable prosthesis for primary malignant bone. Springerplus, 2015, 4:793.
9姬涛,郭卫,杨荣利,等.Orthofix单边外固定架在骨肿瘤外科治疗中的应用.中国修复重建外科杂志,2017, 31(10):1161-1167.
10 Watanabe K, Tsuchiya H, Yamamoto N, et al. Over 10-year followup of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis. J Orthop Sci, 2013,18(1):101-109.
11 McCoy TH Jr, Kim HJ, Cross MB, et al. Bone tumor reconstruction with the Ilizarov method. J Surg Oncol, 2013,107(4):343-352.
12杨华清,章耀华,韩庆海,等.微创截骨Ilizarov技术结合髓内钉行股骨延长疗效观察.中国修复重建外科杂志,2018, 32(12):1524-1529.
13 Dimeglio A. Growth in pediatric orthopaedics. J Pediatr Orthop,2001,21(4):549-555.
14 Pritchett JW. Longitudinal growth and growth-plate activity in the lower extremity. Clin Orthop Relat Res, 1992,(275):274-279.
15 Li Y, Liao F, Xu HR, et al. Is there a reliable method to predict the limb length discrepancy after chemotherapy and limb salvage surgery in children with osteosarcoma? Chin Med J(Engl), 2016,129(16):1912-1916.
16 Shapiro F. Developmental patterns in lower-extremity length discrepancies. J Bone Joint Surg(Am), 1982, 64(5):639-651.
17 Kelly PM, Dimeglio A. Lower-limb growth:how predictable are predictions? J Child Orthop, 2008, 2(6):407-415.
2 Daw NC, Neel MD, Rao BN, et al. Frontline treatment of localized osteosarcoma without methotrexate:results of the St. Jude Children's Research Hospital OS99 trial. Cancer, 2011, 117(12):2770-2778.
3 Zhang C, Hu J, Zhu K, et al. Survival, complications and functional outcomes of cemented megapr os theses for high-grade osteosarcoma around the knee. Int Orthop, 2018,42(4):927-938.
4 Mavrogenis AF, Pala E, Angelini A, et al. Proximal tibial resections and reconstructions:clinical outcome of 225 patients. J Surg Oncol,2013,107(4):335-342.
5 Nystrom LM, Morcuende JA. Expanding endoprosthesis for pediatric musculoskeletal malignancy:current concepts and results. Iowa Orthop J, 2010, 30:141-149.
6 Decilveo AP, Szczech BW, Topfer J, at al. Reconstruction using expandable endoprostheses for skeletally immature patients with sarcoma. Orthopedics, 2017,40(1):e157-e163.
7 Eckardt JJ, Kabo JM, Kelley CM, et al. Expandable endoprosthesisreconstruction in skeletally immature patients with tumors. Clin Orthop Relat Res, 2000,(373):51-61.
8 Benevenia J, Patterson F, Beebe K, et al. Results of 20 consecutive patients treated with the Repiphysis expandable prosthesis for primary malignant bone. Springerplus, 2015, 4:793.
9姬涛,郭卫,杨荣利,等.Orthofix单边外固定架在骨肿瘤外科治疗中的应用.中国修复重建外科杂志,2017, 31(10):1161-1167.
10 Watanabe K, Tsuchiya H, Yamamoto N, et al. Over 10-year followup of functional outcome in patients with bone tumors reconstructed using distraction osteogenesis. J Orthop Sci, 2013,18(1):101-109.
11 McCoy TH Jr, Kim HJ, Cross MB, et al. Bone tumor reconstruction with the Ilizarov method. J Surg Oncol, 2013,107(4):343-352.
12杨华清,章耀华,韩庆海,等.微创截骨Ilizarov技术结合髓内钉行股骨延长疗效观察.中国修复重建外科杂志,2018, 32(12):1524-1529.
13 Dimeglio A. Growth in pediatric orthopaedics. J Pediatr Orthop,2001,21(4):549-555.
14 Pritchett JW. Longitudinal growth and growth-plate activity in the lower extremity. Clin Orthop Relat Res, 1992,(275):274-279.
15 Li Y, Liao F, Xu HR, et al. Is there a reliable method to predict the limb length discrepancy after chemotherapy and limb salvage surgery in children with osteosarcoma? Chin Med J(Engl), 2016,129(16):1912-1916.
16 Shapiro F. Developmental patterns in lower-extremity length discrepancies. J Bone Joint Surg(Am), 1982, 64(5):639-651.
17 Kelly PM, Dimeglio A. Lower-limb growth:how predictable are predictions? J Child Orthop, 2008, 2(6):407-415.