Orthopaedic Oncology Department, Xi Jing Hospital Affiliated to the Fourth Military Medical University, Xi'an, People's Republic of China.
J Surg Oncol. 2012 Sep 15;106(4):411-6. doi: 10.1002/jso.23105. Epub 2012 Mar 22.
Joint-preserving limb salvage surgery has been expected to have good functional outcomes. However, it is still a unsolved problem to perform a joint preserving resection for patients with juxta-articular osteosarcoma invading epiphyseal line. We determined whether irregular osteotomy under image-guided navigation make joint-saving resection possible for juxta-articular osteosarcoma while adhering oncological principles.
We performed joint-preserving limb salvage surgeries on six patients with juxta-articular osteosarcoma of the long bone. Three lesions located in humerus, two in tibia and one in femur. Two tumors extend to and four beyond the epiphyseal line. CT and MRI data fusion images were applied for intraoperative navigation. Planned irregular osteotomy under image-guided navigation was employed for obtaining clear surgical margin while maximizing host tissue preservation. All tumors were en bloc removed and intercalary defect were reconstructed by allograft in one and combination of allograft with vascularized fibula graft in five patients. All specimens were examined for resection margin. Patients were followed up for average of 17.5 months for evaluating of functional and oncology outcomes.
Entire joint were preserved in three patients and part of joint were saved in another three patients. Clear surgical margin was obtained in all specimens with a minimum of 6-mm distance between tumor and osteotomy line. No patient experienced a local recurrence. One patient developed lung metastasis and had no evidence of disease at the most recent follow-up. All allografts but one healed during the study period. The MSTS average score was 88.8% at final follow-up.
With careful patient selection, the irregular osteotomy under navigation guidance was proved to be an effective and safe technique for precise tumor resection in joint preserving limb salvage procedures for treating patients with juxta-articular osteosarcomas.
保肢关节保留手术有望获得良好的功能结果。然而，对于关节旁骨肉瘤侵犯骺线的患者，进行保关节切除仍然是一个尚未解决的问题。我们确定了在遵循肿瘤学原则的情况下，在影像导航下进行不规则截骨是否可以为关节旁骨肉瘤进行保肢关节保留手术。
我们对 6 例长骨关节旁骨肉瘤患者进行了保肢关节保留手术。3 个病变位于肱骨，2 个位于胫骨，1 个位于股骨。2 个肿瘤延伸至骺线，4 个肿瘤超出骺线。我们将 CT 和 MRI 数据融合图像应用于术中导航。在影像导航下进行计划的不规则截骨，以获得清晰的手术边界，同时最大限度地保留宿主组织。所有肿瘤均整块切除，1 例采用同种异体骨重建，5 例采用同种异体骨结合带血管腓骨移植重建。所有标本均进行切缘检查。所有患者平均随访 17.5 个月，评估功能和肿瘤学结果。
3 例患者整个关节得以保留，3 例患者部分关节得以保留。所有标本均获得清晰的手术边界，肿瘤与截骨线之间的最小距离为 6mm。无患者出现局部复发。1 例患者发生肺转移，随访时无疾病证据。在研究期间，所有同种异体骨均愈合，除 1 例外，其余均愈合。最终随访时，MSTS 平均评分为 88.8%。
通过仔细的患者选择，导航引导下的不规则截骨被证明是一种有效且安全的技术，可以在保肢关节保留手术中精确切除肿瘤，治疗关节旁骨肉瘤患者。
