儿童膝关节周围骨肉瘤灭活再植与假体置换的短期疗效对比

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摘要目的〓探讨儿童膝关节周围骨肉瘤瘤段灭活再植术与全膝关节肿瘤假体置换术的短期疗效差异。方法〓回顾性分析2019年1月至2022年1月就诊于新疆医科大学附属肿瘤医院骨与软组织肿瘤及黑色素瘤科，行保留骨骺的瘤段灭活再植术和全膝关节肿瘤假体置换术的膝关节周围骨肉瘤26例患者的临床资料，男13例，女13例；年龄8～16岁，平均(11.88±2.42)岁。其中采用瘤段灭活再植手术8例(股骨5例，胫骨3例)，为灭活再植组；采用全膝关节肿瘤假体置换手术方式共18例(股骨9例，胫骨9例)，为假体置换组。比较两组患者一般临床资料，功能评估采用肌肉骨骼肿瘤协会评分(musculoskeletal tumor society，MSTS)，使用膝关节活动度评分(range of motion，ROM)评估膝关节活动范围，术后定期复查X线片评估双下肢长度差异，进行肿瘤学评估以及并发症评估等。结果〓26例膝关节周围骨肉瘤患者，随访20～56个月，平均(29.50±6.46)个月。灭活再植组中双下肢长度差异0.63～1.75 cm，平均(1.03±0.37)cm；假体置换组中双下肢长度差异0.73～4.00 cm，平均(1.96±0.88)cm，两组比较差异有统计学意义(t＝2.86，P＝0.009)。MSTS评分灭活再植组平均为(26.63±1.51)分，假体置换组平均为(24.50±1.89)分，两组MSTS评分比较，差异有统计学意义(t＝2.81，P＝0.01)。瘤段灭活再植组中末次随访膝关节屈曲角度平均为健侧的(62.13±13.78)%；全膝关节肿瘤假体置换组末次随访膝关节屈曲角度平均为健侧的(65.68±10.40)%，两组患者膝关节屈曲角度比较，差异无统计学意义(χ²=1.25，P＝0.26)。结论〓儿童膝关节周围骨肉瘤瘤段灭活再植保留骨骺能够有效保留患肢的生长发育潜能，改善患者关节功能，植骨融合较好，并发症较少，短期随访具有较好的临床疗效。

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	宋宁
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	戴志兵
	江仁兵

关键词 ：骨肉瘤, 骨骺, 液氮灭活, 自体骨, 关节功能

Abstract：Objective〓To investigate the difference in short-term clinical efficacy between inactivation and replantation of tumor segments of periarticular osteosarcoma of the knee joint and total knee tumor prosthesis replacement in children.Methods〓 A retrospective analysis was conducted on clinical data from 26 patients with knee joint osteosarcoma treated in the Bone and Soft Tissue Tumors and Melanoma Department of Xinjiang Medical University Affiliated Tumor Hospital from January 2019 to January 2022.The cohort comprised 13 males and 13 females，ranging in age from 8 to 16 years，with a mean age of (11.88±2.42)years.Eight patients underwent tumor segment inactivation and replantation (5 femur，3 tibia)，forming the inactivation-replantation group，while 18 patients underwent total knee tumor prosthesis replacement surgery (9 femur，9 tibia)，constituting the prosthesis replacement group.Comparisons were made between the two groups in terms of general clinical data，functional assessment using the musculoskeletal tumor society(MSTS) score，knee joint range of motion(ROM) evaluation，regular postoperative X-ray examination，limb length discrepancy evaluation，oncologic assessment，and complication analysis.Results〓The follow-up period for the 26 patients with osteosarcoma around the knee joint ranged from 20 to 56 months，averaging (29.50±6.46)months.In the inactivation and replantation group，the limb length discrepancy ranged from 0.63 to 1.75 cm，averaging (1.03±0.37)cm，while in the prosthesis replacement group，the discrepancy ranged from 0.73 to 4.00 cm，averaging (1.96±0.88)cm.The comparison between the two groups revealed a statistically significant difference in limb length discrepancy (t＝2.86，P＝0.009).The average MSTS score for the inactivation and replantation group was (26.63±1.51)，whereas the prosthesis replacement group scored (24.50±1.89) points on average.This comparison also showed a statistically significant difference in MSTS scores (t＝2.81，P＝0.01).At the final follow-up，the average knee flexion angle in the inactivation and replantation group was (62.13±13.78)% of the healthy side，while the total knee tumor prosthesis replacement group exhibited an average knee flexion angle of (65.68±10.40)% of the healthy side.However，the comparison of knee flexion angles between the two groups did not reveal a statistically significant difference (χ2=1.25，P＝0.26).Conclusion〓In children，the inactivation and reimplantation of periarticular osteosarcoma tumor segments，aimed at preserving the epiphysis，can effectively maintain the growth and development potential of the affected limb.This approach also significantly enhances the joint function of the patient，demonstrating superior implant fusion，fewer complications，and overall，a better clinical outcome during short-term follow-up.

Key words： osteosarcoma epiphysis liquid nitrogen inactivation autologous bone joint function

通讯作者: 江仁兵

作者简介: 宋宁(1999－ )，男，研究生在读，新疆医科大学附属肿瘤医院骨与软组织肿瘤及黑色素瘤科，599040418@qq.com

引用本文:

宋宁，张强，杜俊炜，武峻申，戴志兵，江仁兵. 儿童膝关节周围骨肉瘤灭活再植与假体置换的短期疗效对比[J]. 实用骨科杂志, 2024, 30(6): 502-.
Song Ning，Zhang Qiang，Du Junwei，Wu Junshen，Dai Zhibing，Jiang Renbing. Short-Term Outcomes of Inactivated Reimplantation Versus Prosthetic Replacement of Periarticular Osteosarcoma of the Knee in Children. sygkzz, 2024, 30(6): 502-.

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http://www.sygkzz.com/CN/ 或 http://www.sygkzz.com/CN/Y2024/V30/I6/502

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