中国修复重建外科杂志

中国修复重建外科杂志

一期胫骨近端半关节置换联合二期翻修治疗三例儿童胫骨近端骨肉瘤

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目的探讨一期胫骨近端半关节置换联合二期假体翻修对减少儿童胫骨近端骨肉瘤肢体不等长的可行性及疗效。方法2009 年—2013 年,收治 3 例儿童胫骨近端经典型骨肉瘤(ⅡB 期)患者。男 2 例、女 1 例;年龄分别为 12、13、13 岁。术前化疗 4 个疗程后,一期行胫骨近端瘤段切除、胫骨近端半关节置换术;待患者 20、17、17 岁时行二期假体翻修术。结果3 例患者均顺利完成两期手术。 二期术后双下肢长度相差 19、7、21 mm。二期术后分别随访 13、3、27 个月,患者下肢功能恢复满意,根据美国骨与软组织肿瘤协会功能评分标准(MSTS)评分分别为 26、27、25 分。结论一期胫骨近端半关节置换联合二期翻修手术治疗儿童胫骨近端骨肉瘤,可保留股骨远端生长能力,减少双下肢不等长程度,并获得满意稳定性和良好功能。

ObjectiveTo investigate the feasibility and effectiveness of proximal tibial hemiprosthesis replacement in the first stage and prosthesis revision in the second stage in reducing the risk of length discrepancy of limbs in children with proximal tibial osteosarcoma.MethodsBetween 2009 and 2013, 3 children with conventional osteosarcoma at the proximal tibia (stage ⅡB) were treated. There were 2 boys and 1 girl. They were 12, 13, and 13 years old, respectively. After 4 courses of preoperative chemotherapy, the proximal tumor segmental resection and proximal tibial hemiprosthesis replacement were performed. Then the patients underwent prosthetic revision in the second stage when they were 20, 17, and 17 years old, respectively.ResultsAll patients successfully completed two stages of operations. The length discrepancy of lower limb after the second stage operation were 19, 7, and 21 mm, respectively. Three patients were followed up 13, 3, and 27 months after the second stage operation, and the lower extremities functions were satisfactory. The Musculoskeletal Tumor Society (MSTS) score was 26, 27, and 25, respectively.ConclusionThe proximal tibial hemiprosthesis replacement in the first stage combined with prosthesis revision in the second stage for treating the proximal tibia osteosarcoma in children can keep the distal femur growth ability, reduce the length discreapancy of lower limb, and obtain satisfactory stability and good function.

关键词: 胫骨近端骨肉瘤; 半关节置换; 二期翻修; 肢体不等长; 儿童

Key words: Proximal tibial osteosarcoma; hemiprosthesis replacement; second-stage revision; length discrepancy of lower limb; children

引用本文: 李远, 徐海荣, 单华超, 孙扬, 黄真, 牛晓辉. 一期胫骨近端半关节置换联合二期翻修治疗三例儿童胫骨近端骨肉瘤. 中国修复重建外科杂志, 2019, 33(2): 131-137. doi: 10.7507/1002-1892.201810022 复制

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