Capanna技术治疗儿童与青少年胫骨恶性肿瘤保肢术后骨缺损

Capanna technique for bone defect secondary to tibial malignant tumor resection in children and adolescents

[目的]探讨Capanna技术治疗儿童与青少年胫骨恶性肿瘤保肢术后骨缺损的临床疗效。[方法] 2001年1月～2015年3月,共收治18例儿童与青少年胫骨恶性肿瘤。其中男11例,女7例;年龄5～18岁,平均(11.32±4.02)岁。肿瘤病理分类:骨肉瘤10例,尤文肉瘤6例,软骨肉瘤1例,造釉细胞瘤1例。Enneking分期:6例IAG1T1M0,10例IBG1T2M0,2例IIAG2T1M0。骨缺损部位:胫骨上段4例,中段12例,下段2例。骨缺损长度10～30 cm,平均(15.30±3.92) cm。所有患者均在新辅助化疗后,接受肿瘤切除与Capanna技术骨缺损重建。记录术后骨愈合情况及Mankin评分与MSTS评分。[结果]术中使用异体长管状皮质骨长度10～30 cm,平均(15.11±4.44)cm;游离腓骨长度13～23 cm,平均(19.69±3.00) cm。术后无一例出现切口感染。所有患者均获得随访,随访时间2～15年,平均(8.33±6.00)年。膝关节活动度由术前(125.00±30.00)°改变至末次随访时(128.00±30.00)°,差异无统计学意义(P>0.05)。末次随访时按Mankin标准临床结果优良率94.40%。MSTS评分67～100分,平均(93.14±2.82)分。[结论]对于儿童或青少年胫骨恶性肿瘤保肢手术后产生的骨缺损, Capanna技术治疗效果满意,是值得推荐的治疗方法。

[Objective] To investigate the clinical outcomes of Capanna technique for treatment of bone defect secondary to tibial malignant tumor resection in children and adolescents. [Methods] Between January 2001 and March 2015, 18 patients with tibial malignant tumors were surgically treated in our hospital. The patients, 11 males and 7 females, aged from 5 to 18 years with an average of((11.32±4.02) years. In term of tumor classification, there were 10 osteosarcomas, 6 Ewing’s sarcomas,1 chondrosarcoma and 1 ameloblastoma, while in term of Enneking staging, there were 6 cases in IAG1 T1 M0, 10 cases in IBG1 T2 M0, and 2 cases in IIAG2 T1 M0. All the patients underwent tumor resection and then reconstruction of bone defect with Capanna technique after neoadjuvant chemotherapy. Bone healing, Mankin grade and MSTS score were evaluated. [Results]The bone defects, located at proximal tibia in 4 cases, middle tibia in 12 cases and distal tibia in 2 cases, ranged from 10 to 30 cm with an average of(15.30±3.92) cm. Correspondingly, the diaphysis bone allograft used ranged from 10 to 30 cm with a mean of(15.11±4.44) cm, accompanied with free pedicle fibular autograft from 13 to 23 cm with a mean of(19.69±3.00) cm in length.No infection occurred in any of them after operation. All patients were followed up for 2 to 15 years, with an average of(8.33±6.00) years. One patients with osteosarcoma died of pulmonary metastasis at 55 months postoperatively, and another patient with osteosarcoma received amputation at 73 months after operation due to local recurrence. The range of motion of the affected knees varied from(125.00±30.00) degrees preoperatively to(128.00±30.00) degrees at the latest follow up without a statistically significant difference(P>0.05). At the latest follow up, 94.40% patients were graded as excellent according to Mankin criteria,associated with MSTS score ranged from 67 to 100 with an average of(93.14±2.82). [Conclusion] Capanna technique does achieve satisfactory clinical outcomes, and might be recommended for treatment of bone defect secondary to tibial tumor resection in children and adolescents.