摘要
背景:保留骨骺保肢手术在改善肢体功能、避免术后肢体不等长方面较截肢术有明显的优势,但术后并发症也较截肢手术有明显的增加,主要是感染、移植骨吸收、骨折和内固定松动等。目的:观察保留骨骺灭活再植术治疗儿童股骨远端骨肉瘤的术后肢体功能恢复情况。设计:临床定期随访观察。单位:解放军济南军区总医院。对象:选择于1999-01/2005-01在解放军济南军区总医院骨病科收治的11例骨肉瘤患儿,纳入标准:①经穿刺活检病理组织学证实为骨肉瘤。②化疗前在外院未行切开活检、放疗。③化疗前后经MR检查证实骨肉瘤未穿破骺板,侵袭骨骺,即骨肉瘤与骨骺MR分型中的Ⅰ、Ⅱ型[2]。④所有病变均位于股骨下端。排除标准:经胸片、CT扫描已有远处转移者。纳入患儿中男5例,女6例。年龄4～11岁,平均(8±2)岁。病程1～6个月,所有患儿监护人对手术项目知情同意。方法:①本手术中患儿均按照计划采用MMIA化疗方案用药2疗程,2周后进行保留骨骺的灭活再植术。以股骨远端骨肉瘤为例,硬膜外麻醉或全麻成功后,患儿平卧手术台,取膝关节前内侧切口,切开骨膜,向近端作骨膜下剥离。用线锯截断股骨,仔细分离后切断股骨后侧的骨膜,钝性分离股后侧的血管神经至腘窝,结扎至肿瘤内的血管。切断腓肠肌内外侧头在股骨后髁处的附着点。依据术前MR在距骺板5mm处确定股骨远端截骨平面,应用电锯截断股骨,并用无菌玻片作涂片,以细胞学证实无肿瘤细胞存在。髓内针固定股骨,以螺丝钉交叉固定骨骺,骨缺损处以骨水泥充填。逐层关闭,放置引流管1根。以长腿石膏托固定。术后处理:常规应用抗生素预防感染。引流管拔除的时间以引流量<50mL/d来确定。石膏托固定期间注意指导患儿行下肢功能锻炼。术后12～14d拆线。术后2周同样给予MMIA方案进行化疗。术后8周拆除外固
BACKGROUND： Limb salvage operations with preservation of the epiphysis （LSPPE） had been used clinically in order to overcome discrepancy of affected limb and poorer limb function, but more post-operetion complications existed, including infection, grafting bone resorption, fracture and internal fixation cinch. OBJECTIVE： To study the clinical related matters of inactivated bone replantation with preservation of the epiphysis in children limb salvage with osteosarcoma. DESIGN： Clinical observation regularly SETTING： General Hospital of Jinan Military Area Command of Chinese PLA, MATERIALS： Eleven patients corresponded selected standard and accepted treatment from January 1999 to January 2005. Inclusion criteria： ① All patients should be diagnosed as osteosrcoma with puncture biopsy and histopathology. ②Open biopsy and radiotherapy were not done before chemotherapy. ③ No epiphyseal involvement was found in the MRI, such as Ⅰ, Ⅱ pattern of epiphysis classification system.④ All lesion located at the distal femur. Exclusion criteria： If distal metastasis was found with tung X-ray check and CT scanning, the patient would be excluded this study. There were 5 males, 6 females, and the mean age of （8±2） years old （4-11 years）. The disease history was 1-6 months. METHODS ： ① Two cycles of MMIA schema with high-dose methotrexate （HD-MTX）, adriamycin （ADR） and ifosfamide （IFO） were adopted. After 2 weeks of chemotherapy, the operations of inactivated bone replantation with preservation of the epiphysis were performed. The operation was performed under epidural or general anesthesia. The patient lied on operating table. The knee anteriomedialis incision was adopted. Firstly, femur periosteum was opened beyond proximal end 2-3 cm from tumor, subperiosteum stripping was done to the proximal femur, descend femur with wire saw, separated and disconnected aboral pedosteum, blunt dissecting femur aboral blood vessel and nerves to the popliteal fossa, deligating blood vessel aro
出处
《中国组织工程研究与临床康复》
CAS
CSCD
北大核心
2007年第4期758-762,共5页
Journal of Clinical Rehabilitative Tissue Engineering Research
