Department of Pediatric Orthopaedic Surgery, Lyon Mother and Child Teaching Hospital Center, Civilian Hospital Group of Lyon, Lyon 1 Claude-Bernard University, 59, boulevard Pinel, 69677 Bron, France.
Orthop Traumatol Surg Res. 2012 May;98(3):301-8. doi: 10.1016/j.otsr.2011.11.008. Epub 2012 Apr 5.
AIM: Segmental long-bone defect due to tumor resection remains a challenge to treat. The induced membrane technique is a new alternative for biological reconstruction. During the first stage, a cement spacer is inserted after bone resection and stabilisation. The cement spacer is removed during a second stage procedure performed after chemotherapy, and cortico-cancellous bone autograft was placed in the biological induced chamber. The aim of this study was to assess preliminary results in eight children. PATIENTS AND METHODS: This prospective study included six girls and two boys, with a mean age of 12.1 years (range 9.5 to 18) and treated for a mean 15 cm defect (range 10 to 22 cms) due to resection of osteosarcoma (n=4), Ewing sarcoma (n=3) and low grade sarcoma. All patients except one, were given pre- and postoperative chemotherapy. Surgery was performed for three patients with a distal femur tumor, two patients with a proximal tibial tumor and three patients who had proximal humerus, shaft of humerus and fibular tumors. Fixation was mainly performed with locking compression plate (n=4) and locked nail (n=2). The mean operating times for first and second step procedures were 4.8 and 4h respectively. The healing process was radiologically assessed. RESULTS: After a mean follow-up of 21.6 months (15 to 30), all patients were free of disease and seven had bony union. For the lower limb reconstructions, full weight bearing was possible after a mean of 116 days (range 90 to 150) following the second stage. Mean time to bone union was 4.8 months (1.5 to 10). The early Musculoskeletal Tumor Society (MSTS) score was 25.2/30 (range 20-30). Complications were: non-union (n=1), paradoxical graft resorption (n=1) requiring graft revision. CONCLUSION: This two stage procedure reduces the operating time during the first stage and it also reduces early complications. Rapid bone union is objectively obtained despite major bone resection and the patients receiving chemotherapy. SIGNIFICANCE: The induced membrane technique could be an excellent alternative for biological reconstruction after tumor resection in children.
目的：肿瘤切除导致的节段性长骨缺损仍然是一个治疗难题。诱导膜技术是一种新的生物重建选择。在第一阶段，在骨切除和稳定后插入水泥间隔物。在化疗后进行的第二阶段手术中去除水泥间隔物，并将皮质松质骨自体移植物放置在生物诱导腔内。本研究的目的是评估 8 名儿童的初步结果。
患者和方法：这项前瞻性研究包括 6 名女孩和 2 名男孩，平均年龄 12.1 岁（范围 9.5 至 18 岁），因切除骨肉瘤（n=4）、尤文肉瘤（n=3）和低度恶性肉瘤而治疗平均 15 厘米的缺损（范围 10 至 22 厘米）。除 1 名患者外，所有患者均接受术前和术后化疗。手术治疗 3 例股骨远端肿瘤、2 例胫骨近端肿瘤和 3 例肱骨近端、肱骨干和腓骨肿瘤患者。固定主要采用锁定加压钢板（n=4）和锁定钉（n=2）。第一阶段和第二阶段手术的平均手术时间分别为 4.8 和 4 小时。通过影像学评估愈合过程。
结果：平均随访 21.6 个月（15 至 30 个月）后，所有患者均无疾病且 7 例有骨愈合。对于下肢重建，在第二阶段后平均 116 天（90 至 150 天）即可完全负重。骨愈合的平均时间为 4.8 个月（1.5 至 10 个月）。早期肌肉骨骼肿瘤学会（MSTS）评分 25.2/30（范围 20-30）。并发症包括：骨不连（n=1）、反常移植物吸收（n=1），需要移植物修正。
结论：两阶段手术减少了第一阶段的手术时间，也减少了早期并发症。尽管进行了广泛的骨切除和化疗，患者仍能快速获得客观的骨愈合。
意义：诱导膜技术可能是儿童肿瘤切除后生物重建的一种极好的选择。
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