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目的评估使用肿瘤型人工膝关节置换治疗儿童股骨远端骨肉瘤的治疗效果。方法2003年12月至2008年12月,36例14岁以下股骨远端骨肉瘤儿童患者行肿瘤型人工膝关节置换手术,31例随访数据完整。患者年龄9～14岁,平均12.3±1.6岁。男11例,女20例。所有患者都是未经治疗的IIB期原发骨肉瘤。所有患者都经过标准术前化疗、肿瘤型人工膝关节置换手术及术后化疗。结果手术使用普通单纯铰链式膝关节8例,普通旋转铰链式膝关节11例,特制远端非水泥固定铰链式膝关节12例。边缘切除9例,广泛切除22例。31例患者随访12～75个月,中位随访时间26个月,平均32个月。随访期间死亡13例,存活18例,无瘤生存16例,带瘤生存2例。Kaplan-Meier生存分析显示2年生存率74.1%,3年生存率44.6%。局部复发2例(6.5%)。转移14例(45.2%),其中肺转移10例(32.3%),软组织或骨转移3例(9.7%),肺转移合并软组织转移或骨转移1例(3.2%)。存活且未截肢患者15例,MSTS功能评分平均21.5±4.7分,肢体功能优良率86.7%。三种假体术后功能比较,差异无显著性(P=0.979)。随访期内假体并发症发生率38.7%,其中假体周围感染2例(6.5%),假体松动10例(32.3%)。特制远端非水泥固定铰链式关节并发症低于常规使用关节。结论在标准治疗后,肺转移是导致儿童骨肉瘤患者死亡的主要原因;外科边界与局部复发关系密切,提高保肢的安全性需恰当地选择外科边界;特制远端非水泥固定铰链式人工假体与常规使用人工假体功能无明显差异,并不增加早期并发症发生率。
Objective To evaluate the therapeutic effect of tumor-type artificial knee joint replacement on the treatment of distal femoral osteosarcoma in children. Methods From December 2003 to December 2008, 36 children under 14 years old with femoral distal osteosarcoma underwent tumor-type artificial knee arthroplasty. The data of 31 cases were followed up. Patients aged 9 to 14 years, mean 12.3 ± 1.6 years. There were 11 males and 20 females. All patients were untreated stage IIB primary osteosarcoma. All patients underwent standard preoperative chemotherapy, tumor-type artificial knee replacement and postoperative chemotherapy. Results The operation was performed on 8 cases of simple plain knee joint, 11 cases of common rotating knee joint and 12 cases of special non-cement fixed distal knee joint. Marginal resection in 9 cases, extensive resection in 22 cases. 31 patients were followed up for 12 to 75 months, the median follow-up time was 26 months, an average of 32 months. During the follow-up period, 13 cases died, 18 cases survived, 16 cases survived without tumor and 2 cases survived with tumor. Kaplan-Meier survival analysis showed a 2-year survival rate of 74.1% and a 3-year survival rate of 44.6%. Local recurrence in 2 cases (6.5%). There were 14 cases (45.2%) with pulmonary metastasis in 10 cases (32.3%), 3 cases with soft tissue or bone metastasis (9.7%), 1 case with lung metastasis with soft tissue metastasis or bone metastasis (3.2%). Fifteen surviving and non-amputated patients had an MSTS score of 21.5 ± 4.7 on average and 86.7% of the patients had excellent functional status. Three prostheses postoperative function comparison, the difference was not significant (P = 0.979). During the follow-up period, the incidence of prosthetic complications was 38.7%. Among them, 2 cases (6.5%) were infected around prosthesis and 10 cases (32.3%) were loosed. Special distal cement-free articulated joint complications were lower than conventionally used joints. Conclusions Lung metastasis is the major cause of mortality in pediatric patients with osteosarcoma after standard therapy. The surgical border is closely related to local recurrence. Surgical margin should be chosen properly to improve the safety of limb salvage. The special distal non-cement fixed articulated artificial prosthesis Body and conventional prosthesis use no significant difference in function, does not increase the incidence of early complications.