目的探讨可延长半关节假体置换治疗儿童下肢骨肉瘤术后假体相关并发症发生原因及防治策略。方法 2006年5月-2012年10月,共11例下肢骨肉瘤患儿行瘤段切除、可延长半关节假体置换术。男6例,女5例;年龄7~12岁,平均9.3岁。股骨远端6例,股骨近端2例,胫骨近端3例。病程2~8个月,平均3.6个月。根据Enneking分期:ⅡA期3例,ⅡB期8例。术前肺部CT和ECT检查示,肿瘤无转移及多发。术前全部患儿接受4次化疗。结果术后10例切口Ⅰ期愈合,1例术后1周发生感染,经对症处理后愈合。术后9例接受12次化疗,另2例分别接受了2次和4次化疗。1例因局部复发后多处转移死亡;3例出现肺转移,其中2例死亡,另1例切除单发肺转移灶后存活。存活的8例患儿获随访25~89个月,平均42.5个月。1例股骨近端假体发生松动并脱位,3例股骨远端假体分别发生松动下沉、半脱位、延长后退缩;假体相关并发症发生率为50%。存活患儿中3例接受1次延长术,1例2次延长术;其余4例尚未行延长术。末次随访时,根据Enneking肢体恶性肿瘤保肢术后功能评价标准,获优1例,良3例,可3例,差1例,优良率为50%。结论可延长半关节假体置换治疗儿童下肢骨肉瘤术后,存在假体松动下沉、脱位、关节不稳、延长后退缩等假体相关并发症,在提高假体设计、制造水平的同时术中骨水泥、人工补片及术后限制性支具的使用,可减少假体相关并发症发生。 Objective To explore the causes of postoperative complications related to prosthesis and the prevention and treatment strategies for the treatment of lower extremity osteosarcoma in children with semi-joint prosthesis replacement. Methods From May 2006 to October 2012, a total of 11 children with osteosarcoma of the lower extremity underwent resection of the tumor segment, which could prolong the half-joint prosthesis replacement. 6 males and 5 females; aged 7 to 12 years, mean 9.3 years. 6 cases of distal femur, 2 cases of proximal femur and 3 cases of proximal tibia. Course of 2 to 8 months, an average of 3.6 months. According to Enneking staging: Ⅱ A period in 3 cases, Ⅱ B period in 8 cases. Preoperative lung CT and ECT examination showed no tumor metastasis and multiple. All patients received four preoperative chemotherapy. Results After the operation, 10 incisions healed in the first stage and 1 case was infected one week after the operation, healed after symptomatic treatment. Nine patients underwent 12 cycles of chemotherapy and the other two received 2 and 4 cycles of chemotherapy, respectively. One patient died of multiple metastasis after local recurrence; three patients had lung metastases, of which two died and the other survived after removal of single lung metastases. Eight patients who survived were followed up for 25-89 months with an average of 42.5 months. One case of proximal femoral prosthesis loosening and dislocation, three cases of distal femoral prosthesis were loose subsidence, subluxation, extended after the withdrawal; prosthesis-related complications was 50%. Three of the surviving children received one extension and one extension of two; the remaining four had no extension. At the last follow-up, according to the functional evaluation criteria of limb salvage after Enneking limb malignancy, the results were excellent in 1 case, good in 3 cases, fair in 3 cases and poor in 1 case. The excellent and good rate was 50%. CONCLUSION: Prosthetic related complications such as loose subsidence, dislocation, joint instability and prolonged retraction may be prolonged after hemiarthroplasty replacement for the treatment of lower extremity osteosarcoma in children. While improving prosthesis design and manufacturing level The use of cement, artificial patches and post-operative restraints can reduce the incidence of prosthetic-related complications.