Objective： The aim of the study was to analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, a...Objective： The aim of the study was to analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, and the joint functional results after tumor resection. Methods： Between December 1995 and January 2003, 33 cases of preserving epiphysis procedure had been done. In this group, the tumor located in distal femur in 24 cases and in proximal tibia in 9 cases. There were 23 osteosarcomas, 6 Ewing＇s sarcomas, 2 chondrosarcomas, and 2 aggressive osteoblastomas. The patients received 2-4 cycles of preoperative adjuvant chemotherapy, and another 6 cycles after surgery. The modified protocol T10 was taken. Radiography and MRI were used to determine the margins of the tumors preoperatively and histological examination was used to corroborate the evidence intraoperatively. The tumors were staged clinically. Among them, there were 2 cases in ⅠA, 2 cases in ⅠB, 17 cases in ⅡA, and 12 cases in liB. According to the MRI analysis, the metaphyseal tumors in children were classified into 3 types. Type Ⅰ, with the tumor close to but not contacting epiphyseal plate, and the distance between the two over 2 cm, was taken as absolute indication for the technique. Type Ⅱ, with the tumor near or contacting epiphysis plate, and the distance between the two less than 1 cm, was taken as relative indication for the surgery. For type Ⅲ, the tumor contacted the epiphyseal plate partially, and was over 2 cm beyond the joint. In the cohort, 18 cases were categorized as type Ⅰ, 13 as type Ⅱ, and 2 as type Ⅲ. The size of the residual epiphyseal bone segment differed after different excision protocols which were taken according to the clinical classifications. Bone defects after tumor resections were repaired with massive intercalary allograft bone, followed by internal fixation by intramedullary nails and cancellous screws. Results： Among the 33 cases, 3 cases were lost to follow up. 29 cases had complete clin展开更多
文摘Objective： The aim of the study was to analyze the clinical features of limb salvage surgery with epiphyseal preservation in children and adolescents, and to evaluate the recurrence rate, metastasis, complications, and the joint functional results after tumor resection. Methods： Between December 1995 and January 2003, 33 cases of preserving epiphysis procedure had been done. In this group, the tumor located in distal femur in 24 cases and in proximal tibia in 9 cases. There were 23 osteosarcomas, 6 Ewing＇s sarcomas, 2 chondrosarcomas, and 2 aggressive osteoblastomas. The patients received 2-4 cycles of preoperative adjuvant chemotherapy, and another 6 cycles after surgery. The modified protocol T10 was taken. Radiography and MRI were used to determine the margins of the tumors preoperatively and histological examination was used to corroborate the evidence intraoperatively. The tumors were staged clinically. Among them, there were 2 cases in ⅠA, 2 cases in ⅠB, 17 cases in ⅡA, and 12 cases in liB. According to the MRI analysis, the metaphyseal tumors in children were classified into 3 types. Type Ⅰ, with the tumor close to but not contacting epiphyseal plate, and the distance between the two over 2 cm, was taken as absolute indication for the technique. Type Ⅱ, with the tumor near or contacting epiphysis plate, and the distance between the two less than 1 cm, was taken as relative indication for the surgery. For type Ⅲ, the tumor contacted the epiphyseal plate partially, and was over 2 cm beyond the joint. In the cohort, 18 cases were categorized as type Ⅰ, 13 as type Ⅱ, and 2 as type Ⅲ. The size of the residual epiphyseal bone segment differed after different excision protocols which were taken according to the clinical classifications. Bone defects after tumor resections were repaired with massive intercalary allograft bone, followed by internal fixation by intramedullary nails and cancellous screws. Results： Among the 33 cases, 3 cases were lost to follow up. 29 cases had complete clin
