Yao Weitao, Cai Qiqing, Wang Jiaqiang, Gao Songtao
Bone and Soft Department, The Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, Henan 450000, P.R. China.
Oncol Lett. 2017 Nov;14(5):5241-5248. doi: 10.3892/ol.2017.6903. Epub 2017 Sep 6.
Limb sparing surgery in growing young patients with malignant tumors is difficult as invasion of the physis by the tumor or surgical resection through the metaphysis may cause significant limb discrepancy following surgery. At present, hinged tumor prosthesis or biological reconstructions are the main methods following tumor resection in these patients. The aim of the present study was to assess different procedures for the treatment of osteosarcoma around knee joints in immature patients. A retrospective study of 56 patients (<15 years old, open physis) who had been treated for osteosarcoma around the knee joint between January 2007 and December 2015 was performed. Clinical data collected included patient demographics (age at diagnosis, sex and date of diagnosis), tumor characteristics [location, Enneking stage and subtype on magnetic resonance imaging (MRI)], treatment (response to neoadjuvant chemotherapy and type of primary surgery) and clinical outcomes (limb function, discrepancy and overall survival). The median age at the time of diagnosis was 12.14 years (range, 3-15 years). There were 32 male patients (57.1%). A total of 41 (82%) tumors were located at the distal femur, and 15 (18%) at the proximal tibia. A total of 49 (87.5%) patients were diagnosed with stage IIB tumors, and 7 (12.5%) had stage III, according to the Enneking stage classification. Different surgical methods, including amputation, rotation-plasty, endoprosthesis and biological instructions (e.g., allograft) were performed according to MRI type classification. During follow-up, 21 patients (37.5%) succumbed to disease. The Musculoskeletal Tumor Society score ranged from excellent to fair functional result. Recurrence (2 cases, 16.67%) and infection (2, cases, 16.67%) were the main complications following endoprosthesis replacement, while delayed union (12 cases, 57.14%) and fracture (3 cases, 14.29%) were the main causes for biological reconstructions. Limb-length discrepancy ranged from 0-10 cm in limb-saving surgery. The overall survival rate was 57.66% with different cohorts in Enneking stages IIB and III, with or without involvement of the physis and different cycles of chemotherapy. Results of the present study indicated that different limb saving surgeries, including epiphysis/physis preservation with biological construction in patients with MRI types I to III and endoprosthetic/osteoarticular reconstruction in patients with MRI types IV and V, are useful in the management of osteosarcoma in growing young patients with proper surgery indications, and knee joint function was maintained with acceptable complications including limb discrepancy, delayed union, infection, recurrence and fracture.
对于患有恶性肿瘤的青少年患者而言，保肢手术颇具难度，因为肿瘤侵犯骨骺或经干骺端进行手术切除可能会导致术后出现明显的肢体不等长。目前，铰链式肿瘤假体或生物重建是这些患者肿瘤切除后的主要治疗方法。本研究的目的是评估治疗未成熟患者膝关节周围骨肉瘤的不同方法。对2007年1月至2015年12月期间接受膝关节周围骨肉瘤治疗的56例患者（年龄<15岁，骨骺未闭）进行了回顾性研究。收集的临床数据包括患者人口统计学信息（诊断时年龄、性别和诊断日期）、肿瘤特征[位置、磁共振成像（MRI）上的Enneking分期和亚型]、治疗情况（对新辅助化疗的反应和初次手术类型）以及临床结果（肢体功能、不等长和总生存率）。诊断时的中位年龄为12.14岁（范围3 - 15岁）。男性患者32例（57.1%）。共有41例（82%）肿瘤位于股骨远端，15例（18%）位于胫骨近端。根据Enneking分期分类，共有49例（87.5%）患者被诊断为IIB期肿瘤，7例（12.5%）为III期。根据MRI类型分类进行了不同的手术方法，包括截肢、旋转成形术、内置假体和生物重建（如异体骨移植）。随访期间，21例患者（37.5%）死于疾病。肌肉骨骼肿瘤学会评分的功能结果从优秀到中等。内置假体置换后的主要并发症为复发（2例，16.67%）和感染（2例，16.67%），而生物重建的主要原因是骨延迟愈合（12例，57.14%）和骨折（3例，14.29%）。保肢手术中肢体长度不等范围为0 - 10厘米。Enneking IIB期和III期不同队列患者，无论是否累及骨骺以及化疗周期不同，总生存率为57.66%。本研究结果表明，不同的保肢手术，包括对MRI I至III型患者采用保留骨骺/骨骺并进行生物重建，以及对MRI IV和V型患者采用内置假体/骨关节重建，对于有适当手术指征的青少年骨肉瘤患者的治疗是有效的，并且膝关节功能得以维持，并发症包括肢体不等长、骨延迟愈合、感染、复发和骨折等均可接受。
