Grimer R J, Belthur M, Carter S R, Tillman R M, Cool P
Royal Orthopaedic Hospital Oncology Service, Birmingham, England.
J Bone Joint Surg Br. 2000 Mar;82(2):255-60.
Limb salvage is now customary in the treatment of primary bone tumours. The proximal tibia is a frequent site for these neoplasms but reconstruction, especially in children, is a formidable challenge. We reviewed 20 children with extendible replacements of the proximal tibia, all with a minimum follow-up of five years. Five died from their disease and, of the remaining 15, four had above-knee amputations for complications. Infection occurred in seven patients; in five it was related to the lengthening procedure. Aseptic loosening is inevitable in the younger children and only two have avoided a revision, amputation or other major complication; both were aged 12 years at the time of the initial surgery. Despite this, 11 children are alive with a functioning leg and a mean Musculoskeletal Tumour Society functional score of 83%. The lengthening mechanisms used in our series required extensive open operations. We are now using a simpler, minimally invasive, technique which we hope will decrease the incidence of complications. At present, the use of extendible prostheses of the proximal tibia remains an experimental procedure.
保肢目前是原发性骨肿瘤治疗中的常规方法。胫骨近端是这些肿瘤的常见发病部位，但重建手术，尤其是在儿童中，是一项艰巨的挑战。我们回顾了20例接受胫骨近端可延长置换术的儿童患者，所有患者的最短随访时间均为5年。5例患者死于疾病，其余15例中，4例因并发症接受了膝上截肢。7例患者发生感染；其中5例与延长手术有关。年幼患儿不可避免地会出现无菌性松动，只有2例避免了翻修、截肢或其他重大并发症；这2例患者初次手术时均为12岁。尽管如此，11名患儿存活，患侧下肢功能良好，肌肉骨骼肿瘤学会功能评分平均为83%。我们系列研究中使用的延长装置需要进行广泛的开放手术。我们现在正在使用一种更简单的微创技术，希望能降低并发症的发生率。目前，胫骨近端可延长假体的使用仍然是一种试验性手术。
