骨骺牽開保留兒童骨肉瘤骨骺的臨床研究_《中國修復重建外科雜志》

作者：

高嵩濤 , 蔡啟卿 , 姚偉濤 , 王家強 , 張鵬 , 王闖建 , 王鑫

河南省腫瘤醫院（鄭州大學附屬腫瘤醫院）骨科（鄭州，450008）;

關鍵詞：

骨肉瘤骨骺牽開術膝關節外固定架

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目的探討采用外固定架行骨骺牽開術保留兒童股骨骨肉瘤遠端骨骺及關節功能的可行性。方法2007年7月－2011年5月，對6例股骨下段成骨性骨肉瘤患兒行外固定架牽引分離股骨遠端骨骺，配合瘤骨切除、大段同種異體骨重建術治療。男 4 例，女 2 例；年齡9～14歲，平均 10.5歲。骨肉瘤按照Enneking外科分期：ⅡA期4例，ⅡB期2例。干骺端骨腫瘤侵襲情況按照San-Julian等的影像學分型標準分型：Ⅰ型3例，Ⅱ型3例。腫瘤范圍6 cm × 4 cm～12 cm × 9 cm。術前行 2 個周期、術后行4個周期COSS 86化療。結果術后1例因同種異體骨排斥反應導致切口愈合不良，經對癥治療后愈合；其余患兒切口均Ⅰ期愈合。6例均獲隨訪，隨訪時間11～56個月，平均37.5個月。1 例因肺部轉移于術后2年死亡。X線片示，隨訪期間未發生內固定物松動、斷裂及骨不愈合等并發癥。末次隨訪時，按照國際保肢協會（ISOLS）評估標準評估，獲優 3 例、良 2 例、可 1 例，優良率 83.3%。患側肢體長度為（62.97 ± 7.51） cm，與健側（64.03 ± 7.47）cm相似，比較差異無統計學意義（t=0.246 6，P=0.813 4）。結論在嚴格把握適應證、規范化療和徹底切除瘤骨前提下，骨骺牽開術可較好地保留股骨成骨性骨肉瘤患兒的患肢生長機能及關節功能。

引用本文： 高嵩濤,蔡啟卿,姚偉濤,王家強,張鵬,王闖建,王鑫. 骨骺牽開保留兒童骨肉瘤骨骺的臨床研究. 中國修復重建外科雜志, 2012, 26(11): 1291-1295. doi: 復制

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10.	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.
11.	Song SH, Kim SE, Agashe MV, et al. Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia. J Bone Joint Surg (Br), 2012, 94(4): 556-563.
12.	Scott RT, Kissel C, Miller A. Correction of longitudinal epiphyseal bracket disease with external fixation: a case report with 6-year follow-up period. J Foot Ankle Surg, 2011, 50(6): 714-717.
13.	Jesus-Garcia R, Seixas MT, Costa SR, et al. Epiphyseal plate involvement in osteosarcoma. Clin Orthop Relat Res, 2000, (373): 32-38.
14.	Kaste SC. Imaging pediatric bone sarcomas. Radiol Clin North Am, 2011, 49(4): 749-765.
15.	Cho HS, Oh JH, Han I, et al. Joint-preserving limb salvage surgery under navigation guidance. J Surg Oncol, 2009, 100(3): 227-232.
16.	Kiatisevi P, Witoonchart K, Pattarabanjird N, et al. Palliative limb salvage using a retrograde nail-cement composite after intercalary resection of a distal femoral osteosarcoma: a case report. J Orthop Surg (Hong Kong), 2009, 17(3): 383-387.
17.	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.
18.	Sales de Gauzy J, Accadbled F, Gomez Brouchet A, et al. Case report: histologic study of a human epiphyseal transplant at 3 years after implantation. Clin Orthop Relat Res, 2009, 467(7): 1915-1920.
19.	Avila G, Neiva R, Misch CE, et al. Clinical and histologic outcomes after the use of a novel allograft for maxillary sinus augmentation: a case series. Implant Dent, 2010, 19(4): 330-341.
20.	Tsuchiya H, Tomita K, Mori Y, et al. Marginal excision for osteosarcoma with caffeine assisted chemotherapy. Clin Orthop Relat Res, 1999, (358): 27-35.

1. Yoshida Y, Osaka S, Tokuhashi Y. Analysis of limb function after various reconstruction methods according to tumor location following resection of pediatric malignant bone tumors. World J Surg Oncol, 2010, 8: 39.
2. Gaston CL, Tillman RM, Grimer RJ. Distal femoral physeal growth arrest secondary to a cemented proximal femoral endoprosthetic replacement. J Bone Joint Surg (Br), 2011, 93(5): 708-710.
3. Rosen G, Caparros B, Huvos AG, et al. Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer, 1982, 49(6): 1221-1230.
4. San-Julian M, Dölz R, Garcia-Barrecheguren E, 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.
5. Duffaud F, Egerer G, Ferrari S, et al. A phase II trial of second-line pemetrexed in adults with advanced/metastatic osteosarcoma. Eur J Cancer, 2012, 48(4): 564-570.
6. Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of theepiphysis. Physeal distraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
7. Mavrogenis AF, Mitsiokapa EA, Sakellariou VI, et al. Functional and radiographic outcome after tumor limb salvage surgery using STANMORE megaprostheses. J BUON, 2011, 16(2): 353-360.
8. 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.
9. Yu XC, Xu M, Song RX, et al. Marginal resection for osteosarcoma with effective preoperative chemotherapy. Orthop Surg, 2009, 1(3): 196-202.
10. 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.
11. Song SH, Kim SE, Agashe MV, et al. Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia. J Bone Joint Surg (Br), 2012, 94(4): 556-563.
12. Scott RT, Kissel C, Miller A. Correction of longitudinal epiphyseal bracket disease with external fixation: a case report with 6-year follow-up period. J Foot Ankle Surg, 2011, 50(6): 714-717.
13. Jesus-Garcia R, Seixas MT, Costa SR, et al. Epiphyseal plate involvement in osteosarcoma. Clin Orthop Relat Res, 2000, (373): 32-38.
14. Kaste SC. Imaging pediatric bone sarcomas. Radiol Clin North Am, 2011, 49(4): 749-765.
15. Cho HS, Oh JH, Han I, et al. Joint-preserving limb salvage surgery under navigation guidance. J Surg Oncol, 2009, 100(3): 227-232.
16. Kiatisevi P, Witoonchart K, Pattarabanjird N, et al. Palliative limb salvage using a retrograde nail-cement composite after intercalary resection of a distal femoral osteosarcoma: a case report. J Orthop Surg (Hong Kong), 2009, 17(3): 383-387.
17. 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.
18. Sales de Gauzy J, Accadbled F, Gomez Brouchet A, et al. Case report: histologic study of a human epiphyseal transplant at 3 years after implantation. Clin Orthop Relat Res, 2009, 467(7): 1915-1920.
19. Avila G, Neiva R, Misch CE, et al. Clinical and histologic outcomes after the use of a novel allograft for maxillary sinus augmentation: a case series. Implant Dent, 2010, 19(4): 330-341.
20. Tsuchiya H, Tomita K, Mori Y, et al. Marginal excision for osteosarcoma with caffeine assisted chemotherapy. Clin Orthop Relat Res, 1999, (358): 27-35.

《中國修復重建外科雜志》

骨骺牽開保留兒童骨肉瘤骨骺的臨床研究

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《中國修復重建外科雜志》

骨骺牽開保留兒童骨肉瘤骨骺的臨床研究

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