• 廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院三骨科（廣州，510405）;

目的探討保留骨骺的轉(zhuǎn)移性骨生長術(shù)在兒童骨肉瘤保肢手術(shù)中的應(yīng)用及早期療效。 方法2010年3月－2011年3月，采用保留骨骺的轉(zhuǎn)移性骨生長術(shù)治療3例骨肉瘤患兒。其中男1例，女2例；年齡 10～14歲。病程2周～3個月。腫瘤位于股骨遠(yuǎn)端1例，脛骨近端2例。按照San-Julian影像學(xué)腫瘤分型均為Ⅱ型，Enneking骨腫瘤外科分型均為ⅡB型。行新輔助化療，手術(shù)截除部分骨骺，保留關(guān)節(jié)面下部分骨骺，予以Ilizarov支架外固定并進行轉(zhuǎn)移性骨生長治療。術(shù)后病理學(xué)檢查確認(rèn)手術(shù)邊界是否安全，觀察傷口愈合情況，有無局部復(fù)發(fā)及遠(yuǎn)處轉(zhuǎn)移，骨轉(zhuǎn)移生長長度、速度、軸線、骨愈合，患肢長度、功能。 結(jié)果術(shù)后病理檢查示3例患兒均獲得安全手術(shù)邊界。1例股骨遠(yuǎn)端傷口Ⅰ期愈合；2例脛骨近端傷口愈合不良，換藥4周愈合。3例均獲隨訪，隨訪時間分別為12、18、24個月。隨訪期間無局部復(fù)發(fā)及遠(yuǎn)處轉(zhuǎn)移發(fā)生。2例外支架固定10個月后出現(xiàn)針道感染，經(jīng)換藥、抗感染治愈。轉(zhuǎn)移性骨生長長度分別是18.0、9.5、16.0 cm，延長速度分別是2.57、2.07、1.20 cm/月。1例出現(xiàn)延長偏移，給予麻醉下調(diào)整。2例于停止延長8個月后獲骨性愈合，拆除外固定支架；1例轉(zhuǎn)移性骨生長欠佳，給予回縮促進骨痂生長。末次隨訪時，3例患兒下肢全長較健側(cè)短縮1.0～1.5 cm，骨盆取骨區(qū)無異常；2例膝關(guān)節(jié)屈曲度分別達90°和120°，1例仍有外支架，功能測量不滿意。 結(jié)論采用保留骨骺的骨轉(zhuǎn)移性生長術(shù)治療兒童骨肉瘤，通過自體骨段延長的方式修復(fù)骨缺損，為兒童保肢治療提供了新的選擇。

引用本文： 方斌,易春智,張華,張慶文,李勇,魏秋實,何偉,曾作青. 保留骨骺的轉(zhuǎn)移性骨生長術(shù)治療兒童骨肉瘤的初步研究. 中國修復(fù)重建外科雜志, 2013, 27(1): 45-49. doi: 復(fù)制

1. Muscolo DL, Ayerza MA, Aponte-Tinao L, et al. Allograft reconstruction after sarcoma resection in children younger than 10 years old. Clin Orthop Relat Res, 2008, 466(8): 1856-1862.
2. Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis. Physea ldistraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
3. San-Julian M, Aquerreta JD, Benito A, et al. Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: relationship between image methods and histological findings. J Pediatr Orthop, 1999, 19(4): 543-548.
4. 王臻, 郭征, 栗向東. 兒童保留骨骺的保肢手術(shù). 第四軍醫(yī)大學(xué)學(xué)報, 2008, 29(4): 289-291.
5. Hegyi M, Semsei AF, Jakab Z, et al. Good prognosis of localized osteosarcoma in young patients treated with limb-salvage surgery and chemotherapy. Pediatr Blood Cancer, 2011, 57(3): 415-422.
6. 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.
7. Pakos EE, Nearchou AD, Grimer RJ, et al. Prognostic factors and outcomes for osteosarcoma: An international collaboration. Eur J Cancer, 2009, 45(13): 2367-2375.
8. Kalifa C, Brugières L, Le Deldy MC. Neoadjuvant treatment in osteosarcomas. Bull Cancer, 2006, 93(11): 1115-1120.
9. Picci P. Osteosarcoma (Osteogenic sarcoma). Orphaner J Rare Dis, 2007, 2: 6.
10. Grimer RJ. Surgical options for children with osteosarcoma. Lancet Oncol, 2005, 6(2): 85-92.
11. Gitelis S, Yergler JD, Sawlani N, et al. Short and long term failure of the modular oncology knee prosthesis. Orthopedics, 2008, 31(4): 362.
12. Balke M, Ahrens H, Streitbürger A, et al. Modular endoprosthetic reconstruction in malignant bone tumors: indications and limits. Recent Results Cancer Res, 2009, 179: 39-50.
13. Abed R, Grimer R. Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev, 2010, 36(4): 342-347.
14. Lewis VO. Limb salvage in the skeletally immature patient. Curr Oncol Rep, 2005, 7(4): 285-292.
15. San-Julian M, Dolz R, Garcia BE, 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.
16. Renard AJ, Veth RP, Schreuder HW, et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol, 2000, 73(4): 198-205.
17. Dotan A, Dadia S, Bickels J, et al. Expandable endoprosthesis for limb-sparing surgery in children: long-term results. J Child Orthop, 2010, 4(5): 391-400.
18. Henderson ER, Pepper AM, Letson GD. What are estimated reimbursements for lower extremity prostheses capable of surgical and nonsurgical lengthening? Clin Orthop Relat Res, 2012, 470(4): 1194-1203.
19. Dominkus M, Krepler P, Schwameis E, et al. Growth prediction in extendable tumor prostheses in children. Clin Orthop Relat Res, 2001, (390): 212-220.
20. Marina N, Gebhardt M, Teot L, et al. Biology and therapeutic advances for pediatric osteosarcoma. Oncologist, 2004, 9(4): 422-441.
21. Ilizarov GA. The tension-stress effect on effect on genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res, 1989, (238): 249-281.
22. Ilizarov GA. The tension-stress effect on effect on genesis and growth of tissues. Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1990, (239): 263-285.
23. Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, et al. Osteosarcoma around the knee. intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Joint Surg (Br), 2002, 84(8): 1162-1166.
24. 張立軍, 吉士俊, 周永德, 等. 肢體延長并發(fā)癥及其處理. 中華骨科雜志, 1994, 14(10): 594-596.
  1. 1. Muscolo DL, Ayerza MA, Aponte-Tinao L, et al. Allograft reconstruction after sarcoma resection in children younger than 10 years old. Clin Orthop Relat Res, 2008, 466(8): 1856-1862.
  2. 2. Cañadell J, Forriol F, Cara JA. Removal of metaphyseal bone tumours with preservation of the epiphysis. Physea ldistraction before excision. J Bone Joint Surg (Br), 1994, 76(1): 127-132.
  3. 3. San-Julian M, Aquerreta JD, Benito A, et al. Indications for epiphyseal preservation in metaphyseal malignant bone tumors of children: relationship between image methods and histological findings. J Pediatr Orthop, 1999, 19(4): 543-548.
  4. 4. 王臻, 郭征, 栗向東. 兒童保留骨骺的保肢手術(shù). 第四軍醫(yī)大學(xué)學(xué)報, 2008, 29(4): 289-291.
  5. 5. Hegyi M, Semsei AF, Jakab Z, et al. Good prognosis of localized osteosarcoma in young patients treated with limb-salvage surgery and chemotherapy. Pediatr Blood Cancer, 2011, 57(3): 415-422.
  6. 6. 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.
  7. 7. Pakos EE, Nearchou AD, Grimer RJ, et al. Prognostic factors and outcomes for osteosarcoma: An international collaboration. Eur J Cancer, 2009, 45(13): 2367-2375.
  8. 8. Kalifa C, Brugières L, Le Deldy MC. Neoadjuvant treatment in osteosarcomas. Bull Cancer, 2006, 93(11): 1115-1120.
  9. 9. Picci P. Osteosarcoma (Osteogenic sarcoma). Orphaner J Rare Dis, 2007, 2: 6.
  10. 10. Grimer RJ. Surgical options for children with osteosarcoma. Lancet Oncol, 2005, 6(2): 85-92.
  11. 11. Gitelis S, Yergler JD, Sawlani N, et al. Short and long term failure of the modular oncology knee prosthesis. Orthopedics, 2008, 31(4): 362.
  12. 12. Balke M, Ahrens H, Streitbürger A, et al. Modular endoprosthetic reconstruction in malignant bone tumors: indications and limits. Recent Results Cancer Res, 2009, 179: 39-50.
  13. 13. Abed R, Grimer R. Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev, 2010, 36(4): 342-347.
  14. 14. Lewis VO. Limb salvage in the skeletally immature patient. Curr Oncol Rep, 2005, 7(4): 285-292.
  15. 15. San-Julian M, Dolz R, Garcia BE, 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.
  16. 16. Renard AJ, Veth RP, Schreuder HW, et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol, 2000, 73(4): 198-205.
  17. 17. Dotan A, Dadia S, Bickels J, et al. Expandable endoprosthesis for limb-sparing surgery in children: long-term results. J Child Orthop, 2010, 4(5): 391-400.
  18. 18. Henderson ER, Pepper AM, Letson GD. What are estimated reimbursements for lower extremity prostheses capable of surgical and nonsurgical lengthening? Clin Orthop Relat Res, 2012, 470(4): 1194-1203.
  19. 19. Dominkus M, Krepler P, Schwameis E, et al. Growth prediction in extendable tumor prostheses in children. Clin Orthop Relat Res, 2001, (390): 212-220.
  20. 20. Marina N, Gebhardt M, Teot L, et al. Biology and therapeutic advances for pediatric osteosarcoma. Oncologist, 2004, 9(4): 422-441.
  21. 21. Ilizarov GA. The tension-stress effect on effect on genesis and growth of tissues. Part I. The influence of stability of fixation and soft-tissue preservation. Clin Orthop Relat Res, 1989, (238): 249-281.
  22. 22. Ilizarov GA. The tension-stress effect on effect on genesis and growth of tissues. Part II. The influence of the rate and frequency of distraction. Clin Orthop Relat Res, 1990, (239): 263-285.
  23. 23. Tsuchiya H, Abdel-Wanis ME, Sakurakichi K, et al. Osteosarcoma around the knee. intraepiphyseal excision and biological reconstruction with distraction osteogenesis. J Bone Joint Surg (Br), 2002, 84(8): 1162-1166.
  24. 24. 張立軍, 吉士俊, 周永德, 等. 肢體延長并發(fā)癥及其處理. 中華骨科雜志, 1994, 14(10): 594-596.