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目的探讨保留骨骺的转移性骨生长术在儿童骨肉瘤保肢手术中的应用及早期疗效。方法 2010年3月-2011年3月,采用保留骨骺的转移性骨生长术治疗3例骨肉瘤患儿。其中男1例,女2例;年龄10～14岁。病程2周～3个月。肿瘤位于股骨远端1例,胫骨近端2例。按照San-Julian影像学肿瘤分型均为Ⅱ型,Enneking骨肿瘤外科分型均为ⅡB型。行新辅助化疗,手术截除部分骨骺,保留关节面下部分骨骺,予以Ilizarov支架外固定并进行转移性骨生长治疗。术后病理学检查确认手术边界是否安全,观察伤口愈合情况,有无局部复发及远处转移,骨转移生长长度、速度、轴线、骨愈合,患肢长度、功能。结果术后病理检查示3例患儿均获得安全手术边界。1例股骨远端伤口Ⅰ期愈合;2例胫骨近端伤口愈合不良,换药4周愈合。3例均获随访,随访时间分别为12、18、24个月。随访期间无局部复发及远处转移发生。2例外支架固定10个月后出现针道感染,经换药、抗感染治愈。转移性骨生长长度分别是18.0、9.5、16.0 cm,延长速度分别是2.57、2.07、1.20 cm/月。1例出现延长偏移,给予麻醉下调整。2例于停止延长8个月后获骨性愈合,拆除外固定支架;1例转移性骨生长欠佳,给予回缩促进骨痂生长。末次随访时,3例患儿下肢全长较健侧短缩1.0～1.5 cm,骨盆取骨区无异常;2例膝关节屈曲度分别达90°和120°,1例仍有外支架,功能测量不满意。结论采用保留骨骺的骨转移性生长术治疗儿童骨肉瘤,通过自体骨段延长的方式修复骨缺损,为儿童保肢治疗提供了新的选择。
Objective To investigate the application and early curative effect of metaphyseal metastatic bone growth in limb salvage surgery in children. Methods From March 2010 to March 2011, 3 patients with osteosarcoma were treated with metaphyseal metastatic osteosynthesis. Including 1 male and 2 female; aged 10 to 14 years old. Duration of 2 weeks to 3 months. Tumor located in the distal femur in 1 case, proximal tibia in 2 cases. According to San-Julian imaging, the tumor type was type II, and Enneking bone tumor type was type IIB. New neoadjuvant chemotherapy, surgical excision of part of the epiphysis, retaining the epiphysis of the lower part of the articular surface, to Ilizarov stent external fixation and metastatic bone growth therapy. Postoperative pathological examination confirmed the safety of the surgical border, observed wound healing, with or without local recurrence and distant metastasis, bone metastasis growth length, velocity, axis, bone healing, limb length, function. Results Postoperative pathological examination showed that all three cases had safe surgical boundaries. One case of distal femoral wound healed in the first period, while two cases of proximal tibia wound healed poorly and healed after dressing change for 4 weeks. All patients were followed up for 12,18,24 months. No local recurrence and distant metastasis occurred during follow-up. 2 exception stent fixation needle infection after 10 months, after dressing, anti-infection cure. Metastatic bone growth length were 18.0,9.5,16.0 cm, respectively, the extension rate of 2.57,2.07,1.20 cm / month. One case appeared to extend the offset, to be adjusted under anesthesia. In 2 cases, the bone was healed after 8 months and the external fixator was removed. One case of poor metastatic bone growth was given shrinkage to promote callus growth. At the last follow-up, the total length of the lower limbs was shortened by 1.0-1.5 cm compared with that of the healthy ones, and the pelvis bone area was normal. The flexion of the two knees was 90 ° and 120 °, respectively. Not satisfied with the measurement. CONCLUSIONS: Osteosarcoma is preserved in osteosarcoma of children with preserved metaphyseal bone metastasis. It can repair bone defects by means of prolongation of autologous bone segments, which provides a new choice for limb salvage therapy in children.