摘要
目的探讨瘤段骨射线灭活再植在四肢骨肉瘤切除重建中的早期临床效果。方法自2016年6～12月,我科应用瘤段骨射线灭活再植重建四肢骨肉瘤切除后的骨缺损共6例,男3例,女3例,平均年龄12.7 (11～15)岁。所有病例Enneking分期均为IIB期,肿瘤均位于膝关节周围,其中股骨中下段4例,胫骨中上段2例。截除的瘤段长度平均24.8 (18～35) cm。瘤段骨边界外切除后使用电子直线加速器-X线片前后等中心对穿照射灭活,剂量60 Gy,平均照射30 (25～40) min。灭活后瘤段骨均使用锁定加压钢板固定重建。结果所有病例均获得满意随访,平均随访12.8 (6～18)个月,均未发现复发。1例因肺转移于术后6个月死亡,1例于术后12个月发现肺转移,目前带瘤存活。5例存活病例中,除1例瘤段骨-自体骨断端末次随访时仍不全愈合外,另4例骨折端均获得愈合,平均愈合时间8.5 (6～10)个月。存活病例下肢功能评分(MSTS)平均24.6 (22～29)分。共有3例发生术后并发症,包括1例内固定断裂,2例骨关节灭活后膝关节强直,经二次手术均获得满意效果。结论瘤段骨射线灭活再植是重建四肢骨肉瘤切除后骨缺损的可行方法,具有效果好、安全性高的特点。
Objective To investigate the short-term clinical results of extracorporeal irradiated autograft for the reconstruction after limb osteosarcoma resection in children.Methods From Jun to Dec,2016,we used extracorporeal irradiated autograft to reconstruct the defect after osteosarcoma resection in limbs of children(n=6,3 males and 3 females).The mean age was 12.7 years(range:11-15 years).All were ranked Enneking stage IIB.All tumors located around the knee,including 4 in the femur and 2 in the tibia.The mean length of the autograft was 24.8 cm(range:18-35 cm).After en-bloc resection of the tumor,the autograft underwent bolus irradiation of 60 Gy in isocenter with the mean of 30 min(range:25-40 min).Then reconstruction with the locked compress plate was applied.Results All cases were followed up with a mean of 12.8 months(range:16-18 months).No recurrence was observed.Lung metastasis was found in 2 cases,1 died 6 months after operation and the other one was alive(12 months after operation).In 5 patients alive,bone union was achieved in 4 patients with the mean follow-up of 8.5 months(range:6-10 months).The mean MSTS scores was 24.6(range:22-29).Complications occurred in 3 patients,including 1 fixation breakage and 2 knee stiffness.But all got satisfied results after the second operation.Conclusions Extracorporeal irradiated autograft reconstruction is feasible with good clinical results and high security.
作者
顾志远
王鑫
姚伟涛
田志超
刘志勇
蔡启卿
GU Zhi-yuan;WANG Xin;YAO Wei-tao;TIAN Zhi-chao;LIU Zhi-yong;CAI Qi-qing(Department of Bone and Soft Tissue,the affiliated Cancer Hospital of Zhengzhou University,Zhengzhou,Henan,450008,China)
出处
《中国骨与关节杂志》
CAS
2019年第1期37-41,共5页
Chinese Journal of Bone and Joint
关键词
X线
骨肉瘤
骨移植
X-rays
Osteosarcoma
Bone transplation
