瘤段切除灭活再植治疗儿童股骨恶性骨肿瘤

En bloc excision and reconstruction of the defect with pasteurized autograft for femoral primary malignant bone tumor in childen

目的：探讨瘤段切除灭活再植术在儿童股骨恶性骨肿瘤治疗中的疗效。方法：回顾性研究2008年1月至2011年1月股骨恶性骨肿瘤行瘤段切除灭活再植术治疗的患者11例（男7例，女4例），年龄（11．0±2．5）岁。其中骨肉瘤10例，尤文氏肉瘤1例，按照Enneking方法分期，所有患者均为IIb期。结果：本组病例术后都得到随访，随访时间24-65（42±20）个月，骨折端都达到骨性愈合。术中瘤段骨切除长度（17．5±3．2）cm，手术时间为（180±35）min，出血量（1200±250）mL。术后48h内拔除引流管，引流量为（650±125）mL。1例（9．1％）出现局部皮肤坏死，通过伤口换药3周后伤口逐渐愈合。3处（27．3％）骨折断端骨愈合不良，予以骨折断端自体髂骨植骨后，骨折端愈合。1例（9．1％）发生肺转移，于术后35个月死亡。根据Enneking等肢体肌肉骨骼肿瘤外科治疗重建术后功能评估标准，功能评定优5例，良4例，中1例，差1例，优良率81．2％。结论：瘤段切除灭活再植术对于儿童股骨恶性骨肿瘤是一种可供选择的治疗方法。

Objective： To evaluate the efficacy of femoral primary malignant bone tumors treated by limb salvage, with wide en bloc excision and reconstruction of the defect with recycled pasteurized autograft. Methods： From January 2008 to January 2011, 11 patients （7 males, 4 females）, aged （11.0±2.5） years suffering from femoral primary malignant bone tumors were treated with en bloc excision and reconstruction of the defect with recycled pasteurized autograft. Ten patients were histopathologically diagnosed with high-grade osteosarcoma, and 1 with Ewing＇s sarcoma.According to the Enneking staging system, all patients were in Stage lib. Results： All patients were followed-up for 24-65 （42±20） months and all showed bony union at the last follow-up. The length of tumor bone resection was （17.5±3.2） cm, the operation time was （180±35） min, the intraoperative blood loss was （1200±250） mL, and drainage volume was （650±125） mL. Local skin necrosis occurred in 1 patient （9.1%）, which was resolved by debridement. Nonunion occurred in 3 patients （27.3%）, who were treated by secondary iliac crest cancellous bone grafting.Pulmonary metastasis occurred in 1 patient （9.1%） who died 35 months post-operatively. According to the function assessment by the Enneking system, 5 patients had excellent results, 4 had good results, 1 fair and 1 poor results, with a satisfaction rate of 81.2%. Conclusion： A pasteurized autograft can be an easily accessible and economical alternative for children＇s malignant bone tumor of femurs.