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目的探讨半关节置换术用于儿童膝关节恶性骨肿瘤,以保留膝关节或重建膝关节的疗效~[1]。方法 2002年3月-2009年6月对5例胫骨上端骨肉瘤患儿行半关节假体置换,年龄8~12岁。均为胫骨上端骨肉瘤,肿瘤外科Ennecking分期为Ⅱ B期以下。病变范围9~11cm,术前均行穿刺活检和正规化疗,并根据χ线片、CT、MRI等影像学结果确定病变范围,测量和设计假体大小,假体长度略长于截骨段1~2cm。术后4周在支具保护下行走,并行2个疗程新辅助化疗。结果 5例患儿均成功进行了半关节假体置换,术后除1例局部皮肤坏死,经皮瓣移位修复伤口Ⅱ期愈合外,余患儿伤口均Ⅰ期愈合。随访12-36个月,1例于术后8个月因肿瘤肺转移死亡,余均无肿瘤转移和复发,均能进行日常生活和学习。结论半关节置换用于儿童胫骨上端恶性肿瘤,具有保留正常骨骺及膝关节和重建膝关节优点,同时达到保肢手术的目的,为成年后全关节置换创造了条件。
Objective To investigate the effect of hemiarthroplasty in the treatment of malignant bone tumors in children with knee joint so as to preserve the knee joint or reconstruct the knee joint [1]. Methods From March 2002 to June 2009, 5 patients with upper tibial osteosarcoma were treated with semi-joint prosthesis replacement, aged 8-12 years. All of the upper tibial osteosarcoma, tumor surgery Ennecking stage Ⅱ B below. The lesions ranged from 9 cm to 11 cm. Percutaneous biopsy and formal chemotherapy were performed preoperatively. The extent of the lesion was determined according to χ-ray, CT, MRI and other imaging findings. The size and size of the prosthesis were measured and the length of the prosthesis slightly longer than that of the osteotomy 1 ~ 2cm. After 4 weeks of walking in the brace protection, parallel 2 courses of neoadjuvant chemotherapy. Results All the 5 children underwent successful replacement of the hemi-articular prosthesis, except for 1 case of local skin necrosis and percutaneous transposition of the wounds to repair the second-degree wounds. All the wounds of the remaining children were healed in the first stage. All patients were followed up for 12-36 months. One patient died of tumor lung metastasis at 8 months after operation. No tumor metastasis and recurrence was found in the other patients. All of them were able to carry out daily life and study. Conclusions Hemipartite joint replacement is used in the malignant tumors of the upper tibia in children. It has the advantages of retaining the normal epiphyseal and knee joint and reconstructing the knee joint. At the same time, it achieves the goal of limb salvage surgery and creates the conditions for adult total joint replacement.