保留骨骺的轉移性骨生長術治療兒童骨肉瘤的初步研究_《中國修復重建外科雜志》

作者：

方斌 , 易春智 , 張華 , 張慶文 , 李勇 , 魏秋實 , 何偉 , 曾作青

廣州中醫藥大學第一附屬醫院三骨科（廣州，510405）;

關鍵詞：

保留骨骺保肢手術骨肉瘤轉移性骨生長術并發癥兒童

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目的探討保留骨骺的轉移性骨生長術在兒童骨肉瘤保肢手術中的應用及早期療效。方法2010年3月－2011年3月，采用保留骨骺的轉移性骨生長術治療3例骨肉瘤患兒。其中男1例，女2例；年齡 10～14歲。病程2周～3個月。腫瘤位于股骨遠端1例，脛骨近端2例。按照San-Julian影像學腫瘤分型均為Ⅱ型，Enneking骨腫瘤外科分型均為ⅡB型。行新輔助化療，手術截除部分骨骺，保留關節面下部分骨骺，予以Ilizarov支架外固定并進行轉移性骨生長治療。術后病理學檢查確認手術邊界是否安全，觀察傷口愈合情況，有無局部復發及遠處轉移，骨轉移生長長度、速度、軸線、骨愈合，患肢長度、功能。結果術后病理檢查示3例患兒均獲得安全手術邊界。1例股骨遠端傷口Ⅰ期愈合；2例脛骨近端傷口愈合不良，換藥4周愈合。3例均獲隨訪，隨訪時間分別為12、18、24個月。隨訪期間無局部復發及遠處轉移發生。2例外支架固定10個月后出現針道感染，經換藥、抗感染治愈。轉移性骨生長長度分別是18.0、9.5、16.0 cm，延長速度分別是2.57、2.07、1.20 cm/月。1例出現延長偏移，給予麻醉下調整。2例于停止延長8個月后獲骨性愈合，拆除外固定支架；1例轉移性骨生長欠佳，給予回縮促進骨痂生長。末次隨訪時，3例患兒下肢全長較健側短縮1.0～1.5 cm，骨盆取骨區無異常；2例膝關節屈曲度分別達90°和120°，1例仍有外支架，功能測量不滿意。結論采用保留骨骺的骨轉移性生長術治療兒童骨肉瘤，通過自體骨段延長的方式修復骨缺損，為兒童保肢治療提供了新的選擇。

引用本文： 方斌,易春智,張華,張慶文,李勇,魏秋實,何偉,曾作青. 保留骨骺的轉移性骨生長術治療兒童骨肉瘤的初步研究. 中國修復重建外科雜志, 2013, 27(1): 45-49. doi: 復制

1.	Muscolo DL, Ayerza MA, Aponte-Tinao L, et al. Allograft reconstruction after sarcoma resection in children younger than 10 years old. Clin Orthop Relat Res, 2008, 466(8): 1856-1862.
2.	Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis. Physea ldistraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
3.	San-Julian M, Aquerreta JD, Benito A, et al. Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: relationship between image methods and histological findings. J Pediatr Orthop, 1999, 19(4): 543-548.
4.	王臻, 郭征, 栗向東. 兒童保留骨骺的保肢手術. 第四軍醫大學學報, 2008, 29(4): 289-291.
5.	Hegyi M, Semsei AF, Jakab Z, et al. Good prognosis of localized osteosarcoma in young patients treated with limb-salvage surgery and chemotherapy. Pediatr Blood Cancer, 2011, 57(3): 415-422.
6.	Ferrari S, Ruggieri P, Cefalo G, et al. Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol, 2012, 30(17): 2112-2118.
7.	Pakos EE, Nearchou AD, Grimer RJ, et al. Prognostic factors and outcomes for osteosarcoma: An international collaboration. Eur J Cancer, 2009, 45(13): 2367-2375.
8.	Kalifa C, Brugières L, Le Deldy MC. Neoadjuvant treatment in osteosarcomas. Bull Cancer, 2006, 93(11): 1115-1120.
9.	Picci P. Osteosarcoma (Osteogenic sarcoma). Orphaner J Rare Dis, 2007, 2: 6.
10.	Grimer RJ. Surgical options for children with osteosarcoma. Lancet Oncol, 2005, 6(2): 85-92.
11.	Gitelis S, Yergler JD, Sawlani N, et al. Short and long term failure of the modular oncology knee prosthesis. Orthopedics, 2008, 31(4): 362.
12.	Balke M, Ahrens H, Streitbürger A, et al. Modular endoprosthetic reconstruction in malignant bone tumors: indications and limits. Recent Results Cancer Res, 2009, 179: 39-50.
13.	Abed R, Grimer R. Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev, 2010, 36(4): 342-347.
14.	Lewis VO. Limb salvage in the skeletally immature patient. Curr Oncol Rep, 2005, 7(4): 285-292.
15.	San-Julian M, Dolz R, Garcia BE, et al. Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience. J Pediatr Orthop, 2003, 23(6): 753-762.
16.	Renard AJ, Veth RP, Schreuder HW, et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol, 2000, 73(4): 198-205.
17.	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.
18.	Henderson ER, Pepper AM, Letson GD. What are estimated reimbursements for lower extremity prostheses capable of surgical and nonsurgical lengthening? Clin Orthop Relat Res, 2012, 470(4): 1194-1203.
19.	Dominkus M, Krepler P, Schwameis E, et al. Growth prediction in extendable tumor prostheses in children. Clin Orthop Relat Res, 2001, (390): 212-220.
20.	Marina N, Gebhardt M, Teot L, et al. Biology and therapeutic advances for pediatric osteosarcoma. Oncologist, 2004, 9(4): 422-441.
21.	Ilizarov GA. The tension-stress effect on effect on genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res, 1989, (238): 249-281.
22.	Ilizarov GA. The tension-stress effect on effect on genesis and growth of tissues. Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1990, (239): 263-285.
23.	Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, et al. Osteosarcoma around the knee. intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Joint Surg (Br), 2002, 84(8): 1162-1166.
24.	張立軍, 吉士俊, 周永德, 等. 肢體延長并發癥及其處理. 中華骨科雜志, 1994, 14(10): 594-596.

1. Muscolo DL, Ayerza MA, Aponte-Tinao L, et al. Allograft reconstruction after sarcoma resection in children younger than 10 years old. Clin Orthop Relat Res, 2008, 466(8): 1856-1862.
2. Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis. Physea ldistraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
3. San-Julian M, Aquerreta JD, Benito A, et al. Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: relationship between image methods and histological findings. J Pediatr Orthop, 1999, 19(4): 543-548.
4. 王臻, 郭征, 栗向東. 兒童保留骨骺的保肢手術. 第四軍醫大學學報, 2008, 29(4): 289-291.
5. Hegyi M, Semsei AF, Jakab Z, et al. Good prognosis of localized osteosarcoma in young patients treated with limb-salvage surgery and chemotherapy. Pediatr Blood Cancer, 2011, 57(3): 415-422.
6. Ferrari S, Ruggieri P, Cefalo G, et al. Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol, 2012, 30(17): 2112-2118.
7. Pakos EE, Nearchou AD, Grimer RJ, et al. Prognostic factors and outcomes for osteosarcoma: An international collaboration. Eur J Cancer, 2009, 45(13): 2367-2375.
8. Kalifa C, Brugières L, Le Deldy MC. Neoadjuvant treatment in osteosarcomas. Bull Cancer, 2006, 93(11): 1115-1120.
9. Picci P. Osteosarcoma (Osteogenic sarcoma). Orphaner J Rare Dis, 2007, 2: 6.
10. Grimer RJ. Surgical options for children with osteosarcoma. Lancet Oncol, 2005, 6(2): 85-92.
11. Gitelis S, Yergler JD, Sawlani N, et al. Short and long term failure of the modular oncology knee prosthesis. Orthopedics, 2008, 31(4): 362.
12. Balke M, Ahrens H, Streitbürger A, et al. Modular endoprosthetic reconstruction in malignant bone tumors: indications and limits. Recent Results Cancer Res, 2009, 179: 39-50.
13. Abed R, Grimer R. Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev, 2010, 36(4): 342-347.
14. Lewis VO. Limb salvage in the skeletally immature patient. Curr Oncol Rep, 2005, 7(4): 285-292.
15. San-Julian M, Dolz R, Garcia BE, et al. Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience. J Pediatr Orthop, 2003, 23(6): 753-762.
16. Renard AJ, Veth RP, Schreuder HW, et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol, 2000, 73(4): 198-205.
17. 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.
18. Henderson ER, Pepper AM, Letson GD. What are estimated reimbursements for lower extremity prostheses capable of surgical and nonsurgical lengthening? Clin Orthop Relat Res, 2012, 470(4): 1194-1203.
19. Dominkus M, Krepler P, Schwameis E, et al. Growth prediction in extendable tumor prostheses in children. Clin Orthop Relat Res, 2001, (390): 212-220.
20. Marina N, Gebhardt M, Teot L, et al. Biology and therapeutic advances for pediatric osteosarcoma. Oncologist, 2004, 9(4): 422-441.
21. Ilizarov GA. The tension-stress effect on effect on genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res, 1989, (238): 249-281.
22. Ilizarov GA. The tension-stress effect on effect on genesis and growth of tissues. Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1990, (239): 263-285.
23. Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, et al. Osteosarcoma around the knee. intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Joint Surg (Br), 2002, 84(8): 1162-1166.
24. 張立軍, 吉士俊, 周永德, 等. 肢體延長并發癥及其處理. 中華骨科雜志, 1994, 14(10): 594-596.

《中國修復重建外科雜志》

保留骨骺的轉移性骨生長術治療兒童骨肉瘤的初步研究

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《中國修復重建外科雜志》

保留骨骺的轉移性骨生長術治療兒童骨肉瘤的初步研究

摘要 全文 圖表 視頻 參考文獻 施引文獻 補充材料

Format

Content

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