酒精灭活、射线灭活、液氮灭活3种体外灭活方法治疗儿童股骨骨肉瘤的比较

Comparison of such three in vitro inactivation methods as alcohol inactivation,irradiation inactivation,and liquid nitrogen inactivation for the treatment of femur osteosarcoma in children

目的回顾性分析酒精灭活、射线灭活、液氮灭活3种灭活方法在儿童股骨骨肉瘤保肢治疗中的临床效果及并发症情况,为临床合理选择瘤段骨体外灭活方法提供理论依据。方法回顾性分析2008年1月至2017年12月郑州大学附属肿瘤医院骨软组织科收治的93例股骨骨肉瘤患儿的临床资料,筛选出采用自体瘤段骨体外灭活回植重建治疗的患儿40例,其中男21例,女19例;年龄8~18(13.65±2.87)岁。包括瘤段骨酒精灭活15例,射线灭活12例,液氮灭活13例。比较3种灭活方法治疗儿童股骨骨肉瘤的骨愈合时间、骨愈合率及肿瘤复发率、感染率、骨折或内固定断裂、翻修手术率等并发症情况。结果40例患儿术后均得到有效随访:酒精灭活组随访(102.60±16.55)个月,射线灭活组随访(59.33±6.39)个月,液氮灭活组随访(36.85±6.49)个月,3组随访时间比较差异有统计学意义(P<0.05)。与其他2组比较,酒精灭活组的骨愈合时间较长,骨愈合率较低,感染率、翻修手术率均较高,差异均有统计学意义(均P<0.05);但复发率、骨折或内固定断裂率与其他2组比较差异均无统计学意义(均P>0.05)。射线灭活组与液氮灭活组比较,以上随访指标比较差异均无统计学意义(均P>0.05)。结论3种瘤段骨体外灭活方法对肿瘤灭活均安全可靠,但酒精灭活骨愈合时间长、并发症较多。射线灭活与液氮灭活均可为临床选择,但射线灭活需要专业设备,可能限制其临床应用。

Objective To retrospectively analyze the clinical effects and complications of alcohol inactivation,irradiation inactivation,and liquid nitrogen inactivation in the treatment of femur osteosarcoma in children,in an attempt to provide a theoretical basis for clinical selection of in vitro inactivation methods of tumor bone segment.Methods The clinical data of 93 children with femur osteosarcoma admitted to the Department of Bone and Soft Tissue,the Affi-liate Cancer Hospital of Zhengzhou University from January 2008 to December 2017 were retrospectively analyzed,and 40 children,including 21 males and 19 females,aged 8-18(13.65±2.87)years,who were treated with in vitro inactivation and replantation of autogenous tumor bone segment,were screened.Among these children,there was alcohol inactivation in 15 cases,irradiation inactivation in 12 cases,and liquid nitrogen inactivation in 13 cases.A comparison was drawn on these 3 inactivation methods with respect to bone healing time,bone healing rate,tumor recurrence rate,infection rate,fracture or fixation failure rate,and revision rate.Results All those 40 children were subject to valid medical followed-up,with the alcohol inactivation group for(102.60±16.55)months,the irradiation inactivation group for(59.33±6.39)months,and the liquid nitrogen inactivation for(36.85±6.49)months.The difference in follow-up time of 3 groups was statistically significant(P<0.05).Compared with other 2 groups,the index of bone healing time,bone healing rate,infection rate and revision rate in the alcohol inactivation group were unfavorable,which showed a significant difference(all P<0.05);However,there was no significant difference in the recurrence rate,fracture rate or fixation failure rate compared with other 2 groups(all P>0.05);There was no significant difference in all above indexes between the irradiation group and the liquid nitrogen group(all P>0.05).Conclusions Three in vitro inactivation methods for the treatment of tumor bone segment are safe and reliable.The alcohol inactivated bone has a long healing time and more complications.Both irradiation inactivation and liquid nitrogen inactivation are clinical options,but irradiation inactivation requires professional equipment,which may limit the clinical application.