牵拉成骨术治疗胫骨远端恶性肿瘤的疗效评价

Outcomes of distraction osteogenesis for malignant bone tumors of the distal tibia

目的评价应用牵拉成骨技术修复胫骨远端恶性肿瘤切除术后骨缺损的疗效。方法选取2013年11月至2015年9月6例胫骨远端恶性骨肿瘤患者。骨肉瘤3例,软骨肉瘤2例,侵袭性骨巨细胞瘤III级1例。Enneking外科分期为I A,I B,II A和新辅助化疗效果敏感的II B期骨肉瘤。6例均自踝关节以近行胫骨远端肿瘤扩大切除术,切除后胫骨下端骨缺损长度平均为12(8~15)cm。6例骨缺损患者均行胫骨近端骺线下方2 cm截骨,外固定架固定胫骨,并将中段胫骨向远端牵拉延长修复骨缺损。结果 6例骨缺损全部修复成功,患肢平均短缩19(15~24)mm。骨愈合时间9~17个月,骨愈合指数平均为1.24个月/cm。下肢功能Paley评分优1例,良4例,差1例,优良率83.3%(P>0.05)。结论牵拉成骨术一期修复胫骨远端骨肿瘤切除术后骨缺损疗效满意,下肢功能良好。

Objective To evaluate outcomes of distraction osteogenesis to repair distal tibia bone defects after malignant tumor resection. Methods Six patients diagnosed as malignant bone tumors in the distal tibia were selected from November 2013 to September 2015. Three cases were of osteosarcoma, 2 cases of chondrosarcoma, 1 case of aggressive giant cell tumors of the bone（ level III）. Enneking surgical stage： I A, I B, II A and II B which was sensitive to neoadjuvant chemotherapy. Bone tumors were resected extensively from the ankle joint up to the proximal segment of the tibia with the average length of 12 cm（ range： 8-15 cm） in all 6 cases. Bone cutting was performed at upper tibia 2 cm down to the epiphyseal line. All bone segments were fixed with external fixator and middle segments of the bone were distracted from the proximal to the distal gradually. Results Bone defects were all repaired successfully using this technique with limb shortening of the average of 19 mm（ range： 15-24 mm）. Bone healing time ranged 9-17 months. The average bone healing index was 1.24 months/cm. Lower limb function score according to Paley： excellent in 1 case, good in 4 cases, poor in 1 case, overall excellent and good rate 83.3%（ P 0.05）. Conclusions Effects of distraction osteogenesis are satisfied in repairing distal tibia bone defects after malignant bone tumor resection with good lower limb functions.