儿童膝关节恶性骨肿瘤的手术治疗

Surgical treatment of malignant bone tumor around the knee for children

目的 探讨半关节置换术用于儿童膝关节恶性骨肿瘤,以保留膝关节或重建膝关节的疗效[1] .方法 2002年3月-2009年6月对5例胫骨上端骨肉瘤患儿行半关节假体置换,年龄8～12岁.均为胫骨上端骨肉瘤,肿瘤外科Ennecking分期为Ⅱ B期以下.病变范围9～11cm,术前均行穿刺活检和正规化疗,并根据X线片、CT、MRI等影像学结果 确定病变范围,测量和设计假体大小,假体长度略长于截骨段1～2cm.术后4周在支具保护下行走,并行2个疗程新辅助化疗.结果 5例患儿均成功进行了半关节假体置换,术后除1例局部皮肤坏死,经皮瓣移位修复伤口Ⅱ期愈合外,余患儿伤口均Ⅰ期愈合.随访12-36个月,1例于术后8个月因肿瘤肺转移死亡,余均无肿瘤转移和复发,均能进行日常生活和学习.结论 半关节置换用于儿童胫骨上端恶性肿瘤,具有保留正常骨骺及膝关节和重建膝关节优点,同时达到保肢手术的目的 ,为成年后全关节置换创造了条件.

Objective To investigate the therapeutic effect of semi-joint arthroplasty in the treatment of malignant tumor around the knee for children. Methods From March 2002 to June 2009, 5 children （aged from 8 to 12） who sustained osteosarcoma at the upper end of tibia underwent semi-joint arthroplasty. According to Ennecking staging system, the tumors were of stage IIB and below. The extent of lesion ranged from 4.5 to 5.5 cm radius. Patients underwent aspiration biopsy and chemotherapy preoperatively. The extent of lesion was determined by X-ray images, CT and MRI results. We measured and designed the size of the prosthesis which was 1 to 2 cm longer than the resected bone. Patients could walk with braces 4 weeks after surgery, and underwent 2 courses of neoadjuvant chemotherapy. Results The semi-joint arthroplaty was successfully done for all 5 patients. 1 patient had local skin necrosis, and the wound healed after a flap grafting. Other patients’ wounds healed without complications. 1 patient died of lung metastasis 8 months after surgery. Conclusions The semi-joint arthroplasty in the treatment of malignant tumor around the knee in children can preserve the normal epiphysis and knee joint, and reconstruct the joint so as to save the extremity. It creates conditions for total-joint replacement in future adulthood.