Dominkus M, Krepler P, Schwameis E, Windhager R, Kotz R
Department of Orthopaedics, University Clinic of Vienna, Austria.
Clin Orthop Relat Res. 2001 Sep(390):212-20. doi: 10.1097/00003086-200109000-00024.
Limb salvage procedures for malignant bone tumors of the lower limb in children usualy involve resection of at least one growing physis. To achieve equal leg length, reconstruction relies on accurate prediction of the remaining growth potential of the child. The current authors present the results of predicted growth versus actual prosthetic elongation observed in a group of 15 children fitted with extendable tumor endoprostheses of the lower limb who subsequently have reached skeletal maturity. All patients had at least one of the distal femoral or proximal tibial physes resected for a primary malignant bone tumor. Eight patients underwent distal femoral resection, four patients underwent proximal tibial resection, and three patients had total resection of the femur. All patients received custom-made Howmedica extendable prostheses. In two patients, a newly developed automatic elongation module was used. At followup, between 70 and 158 months, the patients achieved a mean elongation of the surgically treated limb of 10.4 cm (range, 1.1-19.5 cm), which exceeded the predicted growth by 24.3%. Final leg length discrepancies did not exceed 1 cm. Using incremental extendable tumor endoprostheses, individual adaptation of the elongation procedures could be achieved for equalization of leg length discrepancies in children after resection of primary malignant bone tumors of the lower limb.
儿童下肢恶性骨肿瘤的保肢手术通常需要切除至少一个生长中的骨骺。为了实现双下肢等长，重建依赖于对患儿剩余生长潜力的准确预测。本文作者展示了一组15例装配下肢可延长肿瘤假体且随后达到骨骼成熟的患儿的预测生长与实际假体延长情况的结果。所有患者因原发性恶性骨肿瘤至少切除了一侧股骨远端或胫骨近端骨骺。8例患者接受了股骨远端切除，4例患者接受了胫骨近端切除，3例患者进行了全股骨切除。所有患者均接受了定制的Howmedica可延长假体。2例患者使用了新开发的自动延长模块。随访70至158个月时，患者手术治疗肢体的平均延长为10.4 cm（范围1.1 - 19.5 cm），超过预测生长24.3%。最终双下肢长度差异不超过1 cm。使用递增式可延长肿瘤假体，可以实现个体化的延长程序调整，以均衡儿童下肢原发性恶性骨肿瘤切除术后的双下肢长度差异。
