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目的探讨保留骨骺灭活再植术的临床应用注意事项及并发症的防治。方法回顾6年间所治疗的11例患儿,男5例,女6例。平均年龄7.6岁。均位于股骨下端。MR分型:Ⅰ型7例,Ⅱ型4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。结果手术时间为3～4h。术中出血量为300～500ml。无血管、神经损伤。术后切口Ⅰ期愈合,无切口感染及切口延迟愈合。11例获得随访10～72个月,患膝屈曲≥110°3例,90°～110°3例,60°～90°4例,<60°1例。下肢等长4例,患肢较健侧短<2 cm 5例,2～3 cm 2例。复发1例,转移2例,死亡3例,螺钉松动1例,灭活骨骨折1例。结论保留骨骺灭活再植术有利于术后功能恢复和肢体长度的保持;严格无瘤及无菌操作、彻底引流、适当延长外固定的时间、功能锻炼时注意保护肢体等是预防并发症发生的主要措施。
Objective To investigate the clinical application of preserving epiphyseal inactivation replantation precautions and prevention and treatment of complications. Methods A retrospective review of 6 children treated in 11 years, 5 males and 6 females. The average age is 7.6 years old. Are located in the femur. MR classification: Ⅰ type in 7 cases, Ⅱ type in 4 cases. One case complicated with pathological fracture. Treatment methods are used preoperative chemotherapy 2 courses + reserved epiphysis inactivation replantation surgery + postoperative chemotherapy. Results The operation time was 3 ~ 4h. Intraoperative blood loss of 300 ~ 500ml. No blood vessels, nerve damage. Postoperative wound healing, incision infection and delayed incision healing. Eleven patients were followed up for 10 to 72 months. There were 3 cases with knee flexion≥110 °, 3 cases from 90 ° to 110 °, 4 cases from 60 ° to 90 ° and 1 case under 60 °. 4 cases of equal length lower limbs, less than 2 cm shorter limbs in 5 cases, 2 ~ 3 cm in 2 cases. One case had recurrence, two cases had metastasis, three cases died, one case had screw loosening and one case had bone fracture inactivated. Conclusion Retention of epiphyseal metaplasia is beneficial to functional recovery and limb length preservation. Strict tumor-free and aseptic operation, thorough drainage, proper extension of external fixation time, attention to the protection of limbs during functional exercise are the prevention of complications The main measure.