保留股骨骨肉瘤儿童骨骺的临床研究

Clinical observation of epiphysis preservation in children with distal femur osteosarcoma

目的探讨通过骨骺牵开术保留骨肉瘤患儿患侧股骨远端骨骺及膝关节功能的可行性。方法对7例股骨下段骨肉瘤患儿行外固定架牵引以分离股骨远端骨骺，配合瘤骨切除、大段同种异体骨置换术。术后对肿瘤控制、并发症、关节功能、肢体长度等指标进行分析。结果随访12-58个月，所有患儿无局部复发。按照国际保肢学会（ISOLS）评估标准，优良率为71．4％。末次复查患儿健、患侧肢体长度分别为（65．7±2．3）cm、（64．9±2．0）cm，两者比较差异无统计学意义（P〉0．05）。结论骨骺牵开术可较好地保留骨肉瘤患儿的患肢生长机能及肢体功能。

Objective To explore the feasibility of epiphysis and joint function preservation in children with distal femur osteosarcoma using epiphysis distraction by external fixator. Methods Total 7 cases of children with distal femur osteosarcoma underwent epiphysis distraction using external fix- ator combined with tumor resection and repair of defect with massive allograft bone transplantation, ai- ming to preserve the epiphysis of the distal femur and knee joint function. The tumor control probabili- ty （TCP）, complications,joint function and limb length after operation were targeted to analysis. Re- sults The follow-up study （Ranging from 12 to 58 months） was conducted in all case. No recurrence was found in them and 1 case died due to lung metastasis in 2na year after surgery. Referring to the functional evaluation criteria from ISOLS, excellent were seen in 3 cases, good in 2 cases, fair in 2 cases and poor was not found in them. 71.4 percent of cases achieved satisfactory curative efficacy. The final examination in follow up study showed that affect limbs length were （64. 9 ± 2. 0） cm and normal limbs length were （65.7 ± 2. 3） cm respectively. No statistical significance was found between the affected limbs and normal limbs. Conclusions The epiphysis distraction using external fixator is a better way to preserve limb-length and function for children with osteosarcoma.