摘要
目的评估旋转成形术治疗儿童股骨远端骨肉瘤的临床疗效。方法回顾性分析2014年3月-2016年6月采用旋转成形术治疗的10例股骨远端骨肉瘤患儿临床资料。男7例,女3例;年龄4~10岁,平均6.7岁。病理类型:骨母细胞型骨肉瘤4例,混合型骨肉瘤4例,软骨母细胞型骨肉瘤2例。Enneking分期均为ⅡB期。病程3.5~6.0个月,平均4.6个月。术后应用1993年美国骨与软组织肿瘤协会(MSTS93)评分、多伦多下肢功能量表(TESS)评分及膝关节活动度评估患肢功能,影像学检查评估肿瘤复发及转移情况。结果术后1例出现切口延期愈合,经换药后愈合;其余患儿切口均Ⅰ期愈合。10例患儿均获随访,随访时间24~72个月,平均52.6个月。随访期间均无局部复发;3例出现远处转移后死亡1例、无瘤生存1例、带瘤生存1例。2例术后2年足跟部出现胼胝和溃疡,均经处理后好转。骨连接端愈合时间2.5~5.0个月,平均3.5个月。术后4个月患儿均能独立行走。末次随访时,MSTS93评分为19~25分,平均22分;TESS评分为87~93分,平均90分。佩戴假肢后膝关节活动度伸0°~10°,平均5°;屈85°~95°,平均90.5°。结论对于保肢困难的股骨远端骨肉瘤患儿,采用旋转成形术治疗能有效保留患肢功能,改善生活质量,可以作为截肢的备选术式。
Objective To investigate the effectiveness of rotationplasty in treating osteosarcoma of distal femur in children.Methods A clinical data of 10 children with osteosarcoma of distal femur treated with rotationplasty between March 2014 and June 2016 was retrospectively analyzed.There were 7 boys and 3 girls with an average age of 6.7 years(range,4-10 years).There were 4 cases of osteoblastic osteosarcoma,4 cases of mixed osteosarcoma,and 2 cases of chondroblastic osteosarcoma.All children were staged as Enneking stageⅡB.The disease duration ranged from 3.5 to 6.0 months(mean,4.6 months).The lower limb functional scoring system of 1993 Musculoskeletal Tumor Society(MSTS93),Toronto Extremity Salvage Score(TESS),and knee mobility were used to evaluate postoperative function.Tumor recurrence and metastases were monitored by radiograph.Results Poor superficial incision healing occurred in 1 patient,and healed after dressing change.The other incisions healed by first intention.All children were followed up 24-72 months(mean,52.6 months).No local recurrence was observed during follow-up.Three of the ten patients suffered from metastases including 1 dying of multiple organ dysfunction syndrome,1 alive with tumor,and 1 tumor free survival.Painful callosities and ulcers which related to prosthetic wear occurred in 2 patients and turned up after optimizing prosthetic fit and physiotherapy.The fracture healing time was 2.5-5.0 months(mean,3.5 months).All children could walk independently at 4 months postoperatively.At last follow-up,the MSTS93 score was 19-25(mean,22)and the TESS score was 87-93(mean,90).The extension of knee joint mobility with artificial limbs was 0°-10°(mean,5°),and the flexion of knee joint mobility with artificial limbs was 85°-95°(mean,90.5°).Conclusion Rotationplasty in treating osteosarcoma of distal femur in children with limb salvage difficulties can effectively preserve the limb function and improve the quality of life,and it can be used as an alternative to amputation.
作者
赵雪林
刘亚涛
李健雄
毕竟优
许猛
ZHAO Xuelin;LIU Yatao;LI Jianxiong;BI Jingyou;XU Meng(Department of Orthopedics,the First Medical Center of Chinese PLA General Hospital,Beijing,100853,P.R.China)
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2020年第10期1215-1220,共6页
Chinese Journal of Reparative and Reconstructive Surgery
基金
国家自然科学基金资助项目(81972901)
基础加强计划技术领域基金项目(2019-JCJQ-JJ-147)
基础计划加强重点基础研究项目(2019-JCJQ-ZD-120-40)。
关键词
旋转成形术
股骨远端
骨肉瘤
保肢术
儿童
Rotationplasty
distal femur
osteosarcoma
limb salvage
child
