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目的探讨保留骨骺灭活再植术的远期临床疗效及并发症的治疗。方法回顾10年间随访超过5年的5例股骨远端骨肉瘤患者,男1例,女4例。平均年龄9.2岁。MR分型:Ⅰ型3例,Ⅱ型2例。1例合并病理骨折。治疗方法均采用术前化疗2疗程+保留骨骺灭活再植手术+术后化疗。结果5例患者平均随访82个月(60～126个月)。无复发、转移和死亡。3例发生灭活骨骨折,均再次行植骨内固定术,再次术后半年骨愈合良好。患膝屈曲≥110°3例,90°1例,70°1例。双下肢等长1例,患肢短缩<2cm 3例,8cm 1例。肢体功能评分为13～30分,平均25.6分。结论保留骨骺的灭活再植术是一种可行的手术方法,可有满意的临床疗效。关节活动受限和灭活骨骨折是该手术的最常见远期并发症。
Objective To investigate the long-term clinical efficacy and complications of preserving epiphyseal inactivation replantation. Methods Five cases of distal femoral osteosarcoma who were followed up for more than 5 years in 10 years were retrospectively analyzed. There were 1 males and 4 females. The average age of 9.2 years old. MR classification: Ⅰ type in 3 cases, Ⅱ type in 2 cases. One case complicated with pathological fracture. Treatment methods are used preoperative chemotherapy 2 courses + reserved epiphysis inactivation replantation surgery + postoperative chemotherapy. Results Five patients were followed up for an average of 82 months (60-126 months). No recurrence, metastasis and death. In 3 cases, in-bone fractures occurred, all underwent internal fixation with bone grafts again, and bone healing was good after 6 months. 3 cases of knee flexion≥110 °, 1 case of 90 ° and 1 case of 70 °. 1 case of equal length of both lower extremities, 3 cases of limb shortening <2 cm and 1 case of 8 cm. Physical function score 13 to 30 points, an average of 25.6 points. Conclusion The preservation of epiphyseal replantation replantation is a viable surgical method, may have satisfactory clinical efficacy. Limited joint activity and inactivated bone fractures are the most common long-term complications of this procedure.