• 河南省腫瘤醫(yī)院（鄭州大學(xué)附屬腫瘤醫(yī)院）骨科（鄭州，450008）;

目的探討采用外固定架行骨骺牽開術(shù)保留兒童股骨骨肉瘤遠(yuǎn)端骨骺及關(guān)節(jié)功能的可行性。 方法2007年7月－2011年5月，對(duì)6例股骨下段成骨性骨肉瘤患兒行外固定架牽引分離股骨遠(yuǎn)端骨骺，配合瘤骨切除、大段同種異體骨重建術(shù)治療。男 4 例，女 2 例；年齡9～14歲，平均 10.5歲。骨肉瘤按照Enneking外科分期：ⅡA期4例，ⅡB期2例。干骺端骨腫瘤侵襲情況按照San-Julian等的影像學(xué)分型標(biāo)準(zhǔn)分型：Ⅰ型3例，Ⅱ型3例。腫瘤范圍6 cm × 4 cm～12 cm × 9 cm。術(shù)前行 2 個(gè)周期、術(shù)后行4個(gè)周期COSS 86化療。 結(jié)果術(shù)后1例因同種異體骨排斥反應(yīng)導(dǎo)致切口愈合不良，經(jīng)對(duì)癥治療后愈合；其余患兒切口均Ⅰ期愈合。6例均獲隨訪，隨訪時(shí)間11～56個(gè)月，平均37.5個(gè)月。1 例因肺部轉(zhuǎn)移于術(shù)后2年死亡。X線片示，隨訪期間未發(fā)生內(nèi)固定物松動(dòng)、斷裂及骨不愈合等并發(fā)癥。末次隨訪時(shí)，按照國(guó)際保肢協(xié)會(huì)（ISOLS）評(píng)估標(biāo)準(zhǔn)評(píng)估，獲優(yōu) 3 例、良 2 例、可 1 例，優(yōu)良率 83.3%?；紓?cè)肢體長(zhǎng)度為（62.97 ± 7.51） cm，與健側(cè)（64.03 ± 7.47）cm相似，比較差異無(wú)統(tǒng)計(jì)學(xué)意義（t=0.246 6，P=0.813 4）。 結(jié)論在嚴(yán)格把握適應(yīng)證、規(guī)范化療和徹底切除瘤骨前提下，骨骺牽開術(shù)可較好地保留股骨成骨性骨肉瘤患兒的患肢生長(zhǎng)機(jī)能及關(guān)節(jié)功能。

引用本文： 高嵩濤,蔡啟卿,姚偉濤,王家強(qiáng),張鵬,王闖建,王鑫. 骨骺牽開保留兒童骨肉瘤骨骺的臨床研究. 中國(guó)修復(fù)重建外科雜志, 2012, 26(11): 1291-1295. doi: 復(fù)制

1. Yoshida Y, Osaka S, Tokuhashi Y. Analysis of limb function after various reconstruction methods according to tumor location following resection of pediatric malignant bone tumors. World J Surg Oncol, 2010, 8: 39.
2. Gaston CL, Tillman RM, Grimer RJ. Distal femoral physeal growth arrest secondary to a cemented proximal femoral endoprosthetic replacement. J Bone Joint Surg (Br), 2011, 93(5): 708-710.
3. Rosen G, Caparros B, Huvos AG, et al. Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer, 1982, 49(6): 1221-1230.
4. San-Julian M, Dölz R, Garcia-Barrecheguren E, et al. Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience. J Pediatr Orthop, 2003, 23(6): 753-762.
5. Duffaud F, Egerer G, Ferrari S, et al. A phase II trial of second-line pemetrexed in adults with advanced/metastatic osteosarcoma. Eur J Cancer, 2012, 48(4): 564-570.
6. Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of theepiphysis. Physeal distraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
7. Mavrogenis AF, Mitsiokapa EA, Sakellariou VI, et al. Functional and radiographic outcome after tumor limb salvage surgery using STANMORE megaprostheses. J BUON, 2011, 16(2): 353-360.
8. Basener CJ, Mehlman CT, DiPasquale TG. Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma, 2009, 23(9): 663-667.
9. Yu XC, Xu M, Song RX, et al. Marginal resection for osteosarcoma with effective preoperative chemotherapy. Orthop Surg, 2009, 1(3): 196-202.
10. Ferrari S, Ruggieri P, Cefalo G, et al. Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol, 2012, 30(17): 2112-2118.
11. Song SH, Kim SE, Agashe MV, et al. Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia. J Bone Joint Surg (Br), 2012, 94(4): 556-563.
12. Scott RT, Kissel C, Miller A. Correction of longitudinal epiphyseal bracket disease with external fixation: a case report with 6-year follow-up period. J Foot Ankle Surg, 2011, 50(6): 714-717.
13. Jesus-Garcia R, Seixas MT, Costa SR, et al. Epiphyseal plate involvement in osteosarcoma. Clin Orthop Relat Res, 2000, (373): 32-38.
14. Kaste SC. Imaging pediatric bone sarcomas. Radiol Clin North Am, 2011, 49(4): 749-765.
15. Cho HS, Oh JH, Han I, et al. Joint-preserving limb salvage surgery under navigation guidance. J Surg Oncol, 2009, 100(3): 227-232.
16. Kiatisevi P, Witoonchart K, Pattarabanjird N, et al. Palliative limb salvage using a retrograde nail-cement composite after intercalary resection of a distal femoral osteosarcoma: a case report. J Orthop Surg (Hong Kong), 2009, 17(3): 383-387.
17. Yu XC, Xu M, Xu SF, et al. Long-term outcomes of epiphyseal preservation and reconstruction with inactivated bone for distal femoral osteosarcoma of children. Orthop Surg, 2012, 4(1): 21-27.
18. Sales de Gauzy J, Accadbled F, Gomez Brouchet A, et al. Case report: histologic study of a human epiphyseal transplant at 3 years after implantation. Clin Orthop Relat Res, 2009, 467(7): 1915-1920.
19. Avila G, Neiva R, Misch CE, et al. Clinical and histologic outcomes after the use of a novel allograft for maxillary sinus augmentation: a case series. Implant Dent, 2010, 19(4): 330-341.
20. Tsuchiya H, Tomita K, Mori Y, et al. Marginal excision for osteosarcoma with caffeine assisted chemotherapy. Clin Orthop Relat Res, 1999, (358): 27-35.
  1. 1. Yoshida Y, Osaka S, Tokuhashi Y. Analysis of limb function after various reconstruction methods according to tumor location following resection of pediatric malignant bone tumors. World J Surg Oncol, 2010, 8: 39.
  2. 2. Gaston CL, Tillman RM, Grimer RJ. Distal femoral physeal growth arrest secondary to a cemented proximal femoral endoprosthetic replacement. J Bone Joint Surg (Br), 2011, 93(5): 708-710.
  3. 3. Rosen G, Caparros B, Huvos AG, et al. Preoperative chemotherapy for osteogenic sarcoma: selection of postoperative adjuvant chemotherapy based on the response of the primary tumor to preoperative chemotherapy. Cancer, 1982, 49(6): 1221-1230.
  4. 4. San-Julian M, Dölz R, Garcia-Barrecheguren E, et al. Limb salvage in bone sarcomas in patients younger than age 10: a 20-year experience. J Pediatr Orthop, 2003, 23(6): 753-762.
  5. 5. Duffaud F, Egerer G, Ferrari S, et al. A phase II trial of second-line pemetrexed in adults with advanced/metastatic osteosarcoma. Eur J Cancer, 2012, 48(4): 564-570.
  6. 6. Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of theepiphysis. Physeal distraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
  7. 7. Mavrogenis AF, Mitsiokapa EA, Sakellariou VI, et al. Functional and radiographic outcome after tumor limb salvage surgery using STANMORE megaprostheses. J BUON, 2011, 16(2): 353-360.
  8. 8. Basener CJ, Mehlman CT, DiPasquale TG. Growth disturbance after distal femoral growth plate fractures in children: a meta-analysis. J Orthop Trauma, 2009, 23(9): 663-667.
  9. 9. Yu XC, Xu M, Song RX, et al. Marginal resection for osteosarcoma with effective preoperative chemotherapy. Orthop Surg, 2009, 1(3): 196-202.
  10. 10. Ferrari S, Ruggieri P, Cefalo G, et al. Neoadjuvant chemotherapy with methotrexate, cisplatin, and doxorubicin with or without ifosfamide in nonmetastatic osteosarcoma of the extremity: an Italian sarcoma group trial ISG/OS-1. J Clin Oncol, 2012, 30(17): 2112-2118.
  11. 11. Song SH, Kim SE, Agashe MV, et al. Growth disturbance after lengthening of the lower limb and quantitative assessment of physeal closure in skeletally immature patients with achondroplasia. J Bone Joint Surg (Br), 2012, 94(4): 556-563.
  12. 12. Scott RT, Kissel C, Miller A. Correction of longitudinal epiphyseal bracket disease with external fixation: a case report with 6-year follow-up period. J Foot Ankle Surg, 2011, 50(6): 714-717.
  13. 13. Jesus-Garcia R, Seixas MT, Costa SR, et al. Epiphyseal plate involvement in osteosarcoma. Clin Orthop Relat Res, 2000, (373): 32-38.
  14. 14. Kaste SC. Imaging pediatric bone sarcomas. Radiol Clin North Am, 2011, 49(4): 749-765.
  15. 15. Cho HS, Oh JH, Han I, et al. Joint-preserving limb salvage surgery under navigation guidance. J Surg Oncol, 2009, 100(3): 227-232.
  16. 16. Kiatisevi P, Witoonchart K, Pattarabanjird N, et al. Palliative limb salvage using a retrograde nail-cement composite after intercalary resection of a distal femoral osteosarcoma: a case report. J Orthop Surg (Hong Kong), 2009, 17(3): 383-387.
  17. 17. Yu XC, Xu M, Xu SF, et al. Long-term outcomes of epiphyseal preservation and reconstruction with inactivated bone for distal femoral osteosarcoma of children. Orthop Surg, 2012, 4(1): 21-27.
  18. 18. Sales de Gauzy J, Accadbled F, Gomez Brouchet A, et al. Case report: histologic study of a human epiphyseal transplant at 3 years after implantation. Clin Orthop Relat Res, 2009, 467(7): 1915-1920.
  19. 19. Avila G, Neiva R, Misch CE, et al. Clinical and histologic outcomes after the use of a novel allograft for maxillary sinus augmentation: a case series. Implant Dent, 2010, 19(4): 330-341.
  20. 20. Tsuchiya H, Tomita K, Mori Y, et al. Marginal excision for osteosarcoma with caffeine assisted chemotherapy. Clin Orthop Relat Res, 1999, (358): 27-35.