目的 探讨人工补片联合半关节置换术治疗儿童膝关节周围累及骨骺的骨原发性恶性肿瘤的近期临床疗效。 方法 病例系列报告。纳入2019年6月—2022年3月新疆医科大学第一附属医院骨肿瘤外科收治的8例膝关节周围原发性骨恶性肿瘤患儿，其中男4例、女4例，年龄8~13（10.6±1.6）岁。肿瘤位于股骨远端2例、胫骨近端6例。术前穿刺活检病理诊断：骨肉瘤5例，尤文肉瘤3例。所有患儿行人工补片联合半关节置换术治疗。观察项目如下。（1）观察患儿手术时间、术中出血量，以及术后切口感染、膝关节脱位、假体周围骨折、假体断裂及松动等并发症发生情况。（2）术后定期随访：行抽屉试验和侧方应力试验评价膝关节稳定性；行双下肢全长X线片检查，测量下肢长度变化；行膝关节CT及MRI检查，观察假体松动及局部复发情况；行肺部CT和正电子发射体层摄影（PET）/CT检查，观察患儿肿瘤有无肺部转移及其他部位远处转移。术后3个月起采用美国肌肉骨骼肿瘤学会（MSTS）评分系统评价患肢功能，测量患侧膝关节活动度（ROM）评价膝关节活动恢复情况。 结果 8例患儿手术均完成顺利，手术时间150~440（265.2±54.2）min，术中出血量150~400（307.5±98.7）mL。术后1例患儿切口延迟愈合，7例患儿切口一期愈合。8例患儿均获得随访，随访时间7~36（13.8±9.9）个月。随访期间，患儿步态良好，无明显的跛行，无膝关节脱位、假体周围骨折，以及假体断裂、松动等并发症发生。末次随访：膝关节稳定性满意，双下肢全长X线片测量显示双下肢不等长，差值为0.2~2.0（0.9±0.6）cm；行膝关节CT及MRI检查，肿瘤无局部复发，无感染、假体周围骨折、膝关节脱位，无假体断裂、松动等情况；行肺部CT、PET/CT检查，未发现肺部或其他部位肿瘤转移。末次随访时MSTS评分为24~29（27.5±1.5）分，患肢功能均为优；ROM为60°~110°（95°±14.1°），膝关节活动度满意。 结论 人工补片联合半关节置换术治疗儿童膝关节周围累及骨骺的骨原发性恶性肿瘤，可保留对侧正常骨骺，术后可获得满意的膝关节稳定性和功能，近期临床疗效良好。 Objective This study aimed to explore the short-term clinical efficacy of an artificial patch combined with hemiarthroplasty in the treatment of primary bone malignant tumors involving the epiphysis around the knee joint in children. Methods This was a case series report. Eight patients with primary bone malignant tumors around the knee joint who were admitted to the Department of Bone Tumor Surgery, the First Affiliated Hospital of Xinjiang Medical University, from June 2019 to March 2022 were included, including four males and four females, aged 8-13 (10.6±1.6) years, two cases at the distal femur and six cases at the proximal tibia. Five cases of osteosarcoma and three cases of Ewing sarcoma underwent preoperative biopsy pathological examination. All children were treated with an artificial patch combined with hemiarthroplasty. The observation items were as follows: children's operation time, intraoperative blood loss, and postoperative complications such as incision infection, knee dislocation, periprosthetic fractures, and prosthetic breakage and loosening. Regular postoperative observation follow-up was conducted to evaluate the stability of the knee joint by drawer test abd lateral stress test full-length X-rays of both lower limbs were performed to measure changes in the length of the lower limbs CT and MRI examinations of the knee joint were performed to observe prosthetic looseness and local recurrence lung CT and PET-CT examinations were also conducted. Lung metastasis and distant metastasis of the patient's tumor were observed. Three months after surgery, the American Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate the function of the affected limb at follow-up, and the range of motion (ROM) of the affected knee joint was measured to evaluate the recovery of knee joint activity. Results The operation was successfully performed for all eight childen the operation time was 150-440 (265.2±54.2) min, and the intraoperative blood loss was 150-400 (307.5±98.7) mL. After surgery, one patient had delayed incision healing, and seven patients had primary incision healing. All eight children were followed up for 7-36 (13.8±9.9) months. During the follow-up period, the patient's gait was good, with no evident lameness and complications such as knee dislocation, periprosthetic fractures, prosthetic breakage, or loosening. At the last follow-up, the stability of the knee joint was satisfactory. The length of the lower limbs was measured on full-length X-ray films of both lower limbs. The length of the lower limbs was unequal, with a difference of 0.2-2.0 (0.9±0.6) cm. CT and MRI examinations of the knee joint were performed, and no tumors were found. No local recurrence, infection, periprosthetic fracture, knee dislocation, or prosthesis breakage or loosening was observed. Lung CT and PET/CT examinations showed no tumor metastasis. At the last follow-up, the MSTS score was 24-29 (27.5±1.5) points, and the functions of the affected limbs were excellent. In addition, the ROM was 60°-110° (95°±14.1°), and the knee joint mobility was satisfied. Conclusion An artificial patch combined with hemiarthroplasty in the treatment of primary malignant bone tumors involving the epiphysis around the knee joint in children can preserve the normal contralateral epiphysis, achieve satisfactory knee joint stability and function after surgery, and achieve good short-term clinical results.
Short-term clinical efficacy of artificial mesh combined with hemiarthroplasty in the treatment of malignant primary bone tumors involving the epiphysis around the knee joint of children
Objective This study aimed to explore the short-term clinical efficacy of an artificial patch combined with hemiarthroplasty in the treatment of primary bone malignant tumors involving the epiphysis around the knee joint in children. Methods This was a case series report. Eight patients with primary bone malignant tumors around the knee joint who were admitted to the Department of Bone Tumor Surgery, the First Affiliated Hospital of Xinjiang Medical University, from June 2019 to March 2022 were included, including four males and four females, aged 8-13 (10.6±1.6) years, two cases at the distal femur and six cases at the proximal tibia. Five cases of osteosarcoma and three cases of Ewing sarcoma underwent preoperative biopsy pathological examination. All children were treated with an artificial patch combined with hemiarthroplasty. The observation items were as follows: children's operation time, intraoperative blood loss, and postoperative complications such as incision infection, knee dislocation, periprosthetic fractures, and prosthetic breakage and loosening. Regular postoperative observation follow-up was conducted to evaluate the stability of the knee joint by drawer test abd lateral stress test full-length X-rays of both lower limbs were performed to measure changes in the length of the lower limbs CT and MRI examinations of the knee joint were performed to observe prosthetic looseness and local recurrence lung CT and PET-CT examinations were also conducted. Lung metastasis and distant metastasis of the patient's tumor were observed. Three months after surgery, the American Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate the function of the affected limb at follow-up, and the range of motion (ROM) of the affected knee joint was measured to evaluate the recovery of knee joint activity. Results The operation was successfully performed for all eight childen the operation time was 150-440 (265.2±54.2) min, and the intraoperative blood loss was 150-400 (307.5±98.7) mL. After surgery, one patient had delayed incision healing, and seven patients had primary incision healing. All eight children were followed up for 7-36 (13.8±9.9) months. During the follow-up period, the patient's gait was good, with no evident lameness and complications such as knee dislocation, periprosthetic fractures, prosthetic breakage, or loosening. At the last follow-up, the stability of the knee joint was satisfactory. The length of the lower limbs was measured on full-length X-ray films of both lower limbs. The length of the lower limbs was unequal, with a difference of 0.2-2.0 (0.9±0.6) cm. CT and MRI examinations of the knee joint were performed, and no tumors were found. No local recurrence, infection, periprosthetic fracture, knee dislocation, or prosthesis breakage or loosening was observed. Lung CT and PET/CT examinations showed no tumor metastasis. At the last follow-up, the MSTS score was 24-29 (27.5±1.5) points, and the functions of the affected limbs were excellent. In addition, the ROM was 60°-110° (95°±14.1°), and the knee joint mobility was satisfied. Conclusion An artificial patch combined with hemiarthroplasty in the treatment of primary malignant bone tumors involving the epiphysis around the knee joint in children can preserve the normal contralateral epiphysis, achieve satisfactory knee joint stability and function after surgery, and achieve good short-term clinical results.
Bone neoplasmsAround the knee jointEpiphysisHemiarthroplastyArtificial patchChildren
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