Department of Orthopedic Surgery, Nihon University School of Medicine, 30-1 Oyaguchikami-cho, Itabashi-ku, Tokyo 173-8610, Japan.
World J Surg Oncol. 2010 May 19;8:39. doi: 10.1186/1477-7819-8-39.
In the reconstruction of the affected limb in pediatric malignant bone tumors, since the loss of joint function affects limb-length discrepancy expected in the future, reconstruction methods that not only maximally preserve the joint function but also maintain good limb function are necessary. We analysis limb function of reconstruction methods by tumor location following resection of pediatric malignant bone tumors.
We classified the tumors according to their location into 3 types by preoperative MRI, and evaluated reconstruction methods after wide resection, paying attention to whether the joint function could be preserved. The mean age of the patients was 10.6 years, Osteosarcoma was observed in 26 patients, Ewing's sarcoma in 3, and PNET(primitive neuroectodermal tumor) and chondrosarcoma (grade 1) in 1 each.
Type I were those located in the diaphysis, and reconstruction was performed using a vascularized fibular graft(vascularized fibular graft). Type 2 were those located in contact with the epiphyseal line or within 1 cm from this line, and VFG was performed in 1, and distraction osteogenesis in 1. Type III were those extending from the diaphysis to the epiphysis beyond the epiphyseal line, and a Growing Kotz was mainly used in 10 patients. The mean functional assessment score was the highest for Type I (96%: n = 4) according to the type and for VFG (99%) according to the reconstruction method.
The final functional results were the most satisfactory for Types I and II according to tumor location. Biological reconstruction such as VFG and distraction osteogenesis without a prosthesis are so high score in the MSTS rating system. Therefore, considering the function of the affected limb, a limb reconstruction method allowing the maximal preservation of joint function should be selected after careful evaluation of the effects of chemotherapy and the location of the tumor.
在儿童恶性骨肿瘤受累肢体的重建中，由于关节功能的丧失会影响未来预期的肢体长度差异，因此需要采用既能最大限度地保留关节功能，又能保持良好肢体功能的重建方法。我们分析了根据肿瘤切除后位置对儿童恶性骨肿瘤重建方法的肢体功能。
我们根据术前 MRI 将肿瘤分为 3 型，评价广泛切除后重建方法，注意关节功能是否能够保留。患者平均年龄为 10.6 岁，骨肉瘤 26 例，尤文肉瘤 3 例，原始神经外胚层肿瘤和软骨肉瘤（1 级）各 1 例。
Ⅰ型肿瘤位于骨干，采用带血管腓骨移植重建；Ⅱ型肿瘤位于骺板线附近或距骺板线 1cm 以内，1 例行 VFG，1 例行骨延长；Ⅲ型肿瘤从骨干延伸到骺板，超出骺板线，10 例行 Growing Kotz。根据类型，Ⅰ型功能评估平均得分最高（96%：n=4），根据重建方法，VFG 得分最高（99%）。
根据肿瘤位置，Ⅰ型和Ⅱ型的最终功能结果最满意。没有假体的 VFG 和骨延长等生物重建在 MSTS 评分系统中得分很高。因此，考虑到受累肢体的功能，应在仔细评估化疗效果和肿瘤位置的基础上，选择能够最大限度保留关节功能的肢体重建方法。
Zotero 插件