骨骺牽開保骺術在兒童股骨骨肉瘤保肢術中的應用_《中國修復重建外科雜志》

作者：

姚偉濤 , 蔡啟卿 , 高嵩濤 , 王家強 , 張鵬 , 王鑫

河南省腫瘤醫院骨科（鄭州，450000）;

關鍵詞：

骨肉瘤骨骺牽開保骺術保肢術股骨遠端兒童

DOI：

10.7507/1002-1892.20130098

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目的分析骨骺牽開保骺術在兒童股骨骨肉瘤保肢術中的療效及應用價值。方法 2007年1月－2011年1月，收治6例股骨遠端骨肉瘤患兒。男4例，女2例；年齡9～14歲，平均11.4歲。病程1～9個月，平均4.8個月。術前經穿刺或切開活檢證實為骨肉瘤，其中成骨型骨肉瘤1例，軟骨母細胞型骨肉瘤1例，骨母細胞型骨肉瘤1例，未明確細胞分類的骨肉瘤3例。根據Enneking提出的外科分期系統，其中ⅡA期1例，ⅡB期5例。術前采用新輔助化療2個周期；首先行Ca ntilde;adell骨骺牽開保骺術，牽開時間4～7 d，平均5.7 d；骨骺牽開保骺術完成1～2 d后行骨腫瘤切除，采用大段同種異體骨移植重建；術后進一步化療并定期隨訪了解骨折愈合、下肢發育及局部和全身并發癥等情況，并根據美國肌肉骨骼腫瘤學會（MSTS）評分系統評分及雙膝關節活動度（range of motion，ROM）進行功能評定。結果術后發生切口淺表感染1例，經換藥治療后愈合；其余患兒切口均Ⅰ期愈合。6例均獲隨訪，隨訪時間1～5年，平均2.5年；無明顯肢體腫脹及疼痛等癥狀，未發生同種異體骨排斥反應及內固定物松動、斷裂等。術后隨訪無腫瘤轉移及局部復發等并發癥發生。術后6～9個月干骺端骨性愈合5例，14個月1例；骨干部位均發生延遲愈合，術后12～48個月骨折端均有不同程度骨痂形成，但骨折線仍清晰可見。末次隨訪時患肢短縮1～3 cm 4例，3～5 cm 2例；發生代償性脊柱側彎3例，行走明顯跛行2例； MSTS評分為（27.20 ± 1.92）分，與術前（19.60 ± 2.74）分比較差異有統計學意義（t= —4.12，P=0.00）；患側膝關節ROM為（127.00 ± 17.89）°，與術前（109.00 ± 12.45）°比較差異無統計學意義（t= —1.84，P=0.10），與健側膝關節ROM（126.00 ± 9.62）°比較差異無統計學意義（t= —0.11，P=0.92）。結論骨骺牽開保骺術可應用于骨骺尚未閉合的兒童股骨骨肉瘤保肢術中，具有操作簡便、臨床療效好、術后并發癥少等優點。

引用本文： 姚偉濤,蔡啟卿,高嵩濤,王家強,張鵬,王鑫. 骨骺牽開保骺術在兒童股骨骨肉瘤保肢術中的應用. 中國修復重建外科雜志, 2013, 27(4): 423-427. doi: 10.7507/1002-1892.20130098 復制

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11.	Manfrini M, Tiwari A, Ham J, et al. Evolution of surgical treatment for sarcomas of proximal humerus in children: retrospective review at a single institute over 30 years. J Pediatr Orthop, 2011, 31(1): 56-64.
12.	Yu XC, Xu M, Xu SF, et al. Long-term outcomes of epiphyseal preservation and reconstruction with inactivated bone for distal femoral osteosarcoma of children. Orthop Surg, 2012, 4(1): 21-27.
13.	Puri A, Gulia A, Jambhekar N, et al. The outcome of the treatment of diaphyseal primary bone sarcoma by resection, irradiation and re-implantation of the host bone: extracorporeal irradiation as an option for reconstruction in diaphyseal bone sarcomas. J Bone Joint Surg (Br), 2012, 94(7): 982-988.
14.	Betz M, Dumont CE, Fuchs B, et al. Physeal distraction for joint preservation in malignant metaphyseal bone tumors in children. Clin Orthop Relat Res, 2012, 470(6): 1749-1754.
15.	Synder M, Niedzielski K, Borowski A. Complication, difficulties and problems in the application of distraction epiphysiolysis. Orthop Traumatol Rehabil, 2002, 4(4): 464-468.
16.	Weitao Y, Qiqing C, Songtao G, et al. Epiphysis preserving operations for the treatment of lower limb malignant bone tumors. Eur J Surg Oncol, 2012, 38(12): 1165-1170.
17.	Basener CJ, Mehlman CT, DiPasquale TG. Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma, 2009, 23(9): 663-667.
18.	Leary JT, Handling M, Talerico M, et al. Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest. J Pediatr Orthop, 2009, 29(4): 356-361.
19.	Lonjon G, Barthel PY, Ilharreborde B, et al. Bone bridge resection for correction of distal radial deformities after partial growth plate arrest: two cases and surgical technique. J Hand Surg (Eur Vol), 2012, 37(2): 170-175.
20.	Campanacci L, Manfrini M, Colangeli M, et al. Long-term results in children with massive bone osteoarticular allografts of the knee for high-grade osteosarcoma. J Pediatr Orthop, 2010, 30(8): 919-927.

1. 16 Hajdu S, Schwendenwein E, Kaltenecker G, et al. The effect of drilling and screw fixation of the growth plate — an experimental study in rabbits. J Orthop Res, 2011, 29(12): 1834-1839.
2. Kim HJ, Chalmers PN, Morris CD. Pediatric osteogenic sarcoma. Curr Opin Pediatr, 2010, 22(1): 61-66.
3. Arndt CA, Rose PS, Folpe AL, et al. Common musculoskeletal tumors of childhood and adolescence. Mayo Clin Proc, 2012, 87(5): 475-487.
4. Schrager J, Patzer RE, Mink PJ, et al. Survival outcomes of pediatric osteosarcoma and Ewing’s sarcoma: a comparison of surgery type within the SEER database, 1988-2007. J Registry Manag, 2011, 38(3): 153-161.
5. Geller DS, Gorlick R. Osteosarcoma: a review of diagnosis, management, and treatment strategies. Clin Adv Hematol Oncol, 2010, 8(10): 705-718.
6. Abdel-Ghani H, Ebeid W, El-Barbary H. Management of combined nonunion and limb-length discrepancy after vascularised fibular grafting . J Bone Joint Surg (Br), 2010, 92(2): 267-272.
7. Baumgart R, Lenze U. Expandable endoprostheses in malignant bone tumors in children: indications and limitations. Recent Results Cancer Res, 2009, 179: 59-73.
8. Dotan A, Dadia S, Bickels J, et al. Expandable endoprosthesis for limb-sparing surgery in children: long-term results. J Child Orthop, 2010, 4(5): 391-400.
9. Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis. Physeal distraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
10. D’Adamo DR. Appraising the current role of chemotherapy for the treatment of sarcoma. Semin Oncol, 2011, 38(Suppl 3): S19-29.
11. Manfrini M, Tiwari A, Ham J, et al. Evolution of surgical treatment for sarcomas of proximal humerus in children: retrospective review at a single institute over 30 years. J Pediatr Orthop, 2011, 31(1): 56-64.
12. Yu XC, Xu M, Xu SF, et al. Long-term outcomes of epiphyseal preservation and reconstruction with inactivated bone for distal femoral osteosarcoma of children. Orthop Surg, 2012, 4(1): 21-27.
13. Puri A, Gulia A, Jambhekar N, et al. The outcome of the treatment of diaphyseal primary bone sarcoma by resection, irradiation and re-implantation of the host bone: extracorporeal irradiation as an option for reconstruction in diaphyseal bone sarcomas. J Bone Joint Surg (Br), 2012, 94(7): 982-988.
14. Betz M, Dumont CE, Fuchs B, et al. Physeal distraction for joint preservation in malignant metaphyseal bone tumors in children. Clin Orthop Relat Res, 2012, 470(6): 1749-1754.
15. Synder M, Niedzielski K, Borowski A. Complication, difficulties and problems in the application of distraction epiphysiolysis. Orthop Traumatol Rehabil, 2002, 4(4): 464-468.
16. Weitao Y, Qiqing C, Songtao G, et al. Epiphysis preserving operations for the treatment of lower limb malignant bone tumors. Eur J Surg Oncol, 2012, 38(12): 1165-1170.
17. Basener CJ, Mehlman CT, DiPasquale TG. Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma, 2009, 23(9): 663-667.
18. Leary JT, Handling M, Talerico M, et al. Physeal fractures of the distal tibia: predictive factors of premature physeal closure and growth arrest. J Pediatr Orthop, 2009, 29(4): 356-361.
19. Lonjon G, Barthel PY, Ilharreborde B, et al. Bone bridge resection for correction of distal radial deformities after partial growth plate arrest: two cases and surgical technique. J Hand Surg (Eur Vol), 2012, 37(2): 170-175.
20. Campanacci L, Manfrini M, Colangeli M, et al. Long-term results in children with massive bone osteoarticular allografts of the knee for high-grade osteosarcoma. J Pediatr Orthop, 2010, 30(8): 919-927.

《中國修復重建外科雜志》

骨骺牽開保骺術在兒童股骨骨肉瘤保肢術中的應用

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《中國修復重建外科雜志》

骨骺牽開保骺術在兒童股骨骨肉瘤保肢術中的應用

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