Su Alvin W, Chen Wei-Ming, Chen Cheng-Fong, Chen Tain-Hsiung
Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, 201, Sec. 2, Shih-Pai Road, Taipei 11221, Taiwan.
Jpn J Clin Oncol. 2009 Nov;39(11):739-44. doi: 10.1093/jjco/hyp108. Epub 2009 Sep 22.
Reconstruction for osteosarcoma around the knee after wide resection faces the challenge of great bone defect and future limb length discrepancy in the skeletally immature patients. Modern prosthetic reconstruction may provide good results, but the longevity may be of concern and may not be affordable in certain communities. Allograft knee arthrodesis still has its role in light of bone stock preservation and cost-effectiveness.
We developed the innovative trident fixation technique utilizing three Steinmann pins to minimize limb length inequality without jeopardizing knee fusion stability. Twelve patients were enrolled. The mean age was 11.5 (10-13) years. Two had high-grade osteosarcoma in proximal tibia and others in distal femur.
Two patients died of oncological disease. The median follow-up of the disease-free 10 patients was 47 (41-60) months. All allograft-host bone junctions healed uneventfully without major complications except one allograft fracture. The average limb length discrepancy was 1.45 (1.0-2.1) cm at latest follow-up.
This straightforward technique was successful in knee arthrodesis with minimized limb length inequality. Accordingly, in light of bone stock preservation and longevity for the young children, it may be a surgical alternative for malignant bone tumors around the knee.
对于骨骼未成熟的骨肉瘤患者，在广泛切除术后进行膝关节周围重建面临着骨缺损大以及未来肢体长度差异的挑战。现代假体重建可能会取得良好效果，但假体使用寿命可能令人担忧，且在某些地区可能费用高昂。鉴于保留骨量和成本效益，同种异体骨膝关节融合术仍有其作用。
我们开发了一种创新的三叉固定技术，利用三根斯氏针来尽量减少肢体长度不等，同时不影响膝关节融合的稳定性。纳入了12例患者。平均年龄为11.5（10 - 13）岁。2例患者近端胫骨患有高级别骨肉瘤，其他患者远端股骨患病。
2例患者死于肿瘤相关疾病。10例无病患者的中位随访时间为47（41 - 60）个月。除1例同种异体骨骨折外，所有同种异体骨与宿主骨的结合均顺利愈合，无重大并发症。最新随访时肢体长度平均差异为1.45（1.0 - 2.1）厘米。
这种简单的技术在膝关节融合术中成功实现了肢体长度差异最小化。因此，鉴于对幼儿保留骨量和使用寿命的考虑，它可能是膝关节周围恶性骨肿瘤的一种手术替代方案。
