儿童干骺端恶性骨肿瘤切除前的骨骺撑开术:保留关节功能和肢体生长

María García-Carrasco , Carla Carbonell-Rosell , Denisse G. Loya de la Cerda , Marius Aguirre-Cañadell , Roberto Veléz-Villa
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引用次数: 0

摘要

背景影像学方法和辅助化疗的改进使儿童骨肉瘤的存活率提高了80%,因此需要长期的保肢手术。目的描述一系列儿童患者在肿瘤切除前接受了物理牵引治疗干骺端恶性骨肿瘤的病例。方法在2007年1月至2020年12月期间,8名患者(5名男孩和3名女孩),平均年龄7.2岁(2-13岁),作为肿瘤切除方案的第一阶段,接受了物理牵引。6名患者患有尤因肉瘤,2名患者患有骨肉瘤。肿瘤位置为:胫骨近端(4例)、股骨远端、肱骨近端、桡骨远端和腓骨远端(各1例)。6例患者采用同种异体尸体骨置换术;还有一个自体腓骨移植物和一个带血管的腓骨移植物。化疗在术前和术后进行;1例患者接受辅助放射治疗。平均随访62.6个月(8-152)。结果Physeal分心平均持续10.6天(3-15);最终切除的延迟时间为17天(范围为13-22)。平均切除长度为10.7​cm(范围5-14),且均具有负边缘。没有局部复发。三名患者出现疾病进展并伴有转移,最终死亡。手术并发症包括:钉感染(1例)、手术部位感染(2例)、同种异体骨骨折(1名)和骨干连接不愈合(3例)。最终下肢长度差异为1.5​cm(范围1–2​cm)。6例患者关节功能正常。平均MSTS评分为75%(53%-97%)。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Physeal distraction prior to excision of metaphyseal malignant bone tumors in children: Preserving joint function and limb growth

Background

Improvements in imaging methods and adjuvant chemotherapy have increased survival rates in children with bone sarcomas up to 80%, therefore long-lasting limb salvage procedures are needed.

Purpose

To describe a case series of pediatric patients who have undergone physeal distraction prior to tumor resection for treatment of metaphyseal malignant bone tumors.

Methods

Between January 2007 to December 2020, 8 patients (5 boys and 3 girls) with a mean age of 7.2 years (2–13), underwent physeal distraction as the first stage of a tumor resection protocol. Six patients had Ewing's sarcoma and two had osteosarcoma. Tumor locations were: proximal tibia (4 cases), distal femur, proximal humerus, distal radius, and distal fibula (1 case each). The affected bones were replaced with cadaver allograft in 6 patients; there was also one fibula autograft and one vascularized fibula graft. Chemotherapy was administered pre- and post-surgery; one patient received adjuvant radiotherapy. Average follow-up was 62.6 months (8–152).

Results

Physeal distraction lasted an average of 10.6 days (3–15); delay to definitive resection was 17 days (range 13–22). Mean length of resection was 10.7 ​cm (range 5–14) and all had negative margins. There were no local recurrences. Three patients suffered disease progression with metastasis and died. Surgical complications included: pin infection (1 patient), surgical site infection (2 patients), allograft fracture (1 patient), and nonunion of the diaphyseal junction (3 patients). Final lower limb length discrepancy was 1.5 ​cm (range 1–2 ​cm). Normal joint function was achieved in 6 patients. The mean MSTS score was 75% (53%–97%).

Conclusions

Physeal distraction technique is an oncologically safe limb salvage procedure with good functional results, and it should be considered in the treatment of metaphyseal pediatric malignant tumors.

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