儿童患者中带蒂和不带蒂游离腓骨瓣间插异体骨重建胫骨近端。

Intercalary Allograft Reconstruction of the Proximal Tibia With and Without a Free Fibula Flap in Pediatric Patients.

机构信息

Childrens Hospital of Orange County, Orange, CA.

Department of Orthopedic Surgery.

出版信息

J Pediatr Orthop. 2020 Oct;40(9):e833-e838. doi: 10.1097/BPO.0000000000001640.

DOI:10.1097/BPO.0000000000001640

PMID:32701658

Abstract

BACKGROUND

Limb salvage of the proximal tibia can be difficult due to the growth potential of and functional demands of the pediatric patients. Multiple reconstruction techniques exist, however, the ideal form of reconstruction is yet to be elucidated. The purpose of the current study is to evaluate outcomes in patients with an intercalary resection of the proximal tibia reconstructed with an allograft with or without a free vascularized fibula flap (FVF).

METHODS

Seventeen pediatric patients (9 males, 8 females) underwent lower extremity limb salvage with the use of intercalary cadaveric allograft at a mean age of 12±4 years. The most common diagnoses were osteosarcoma (n=6) and Ewing sarcoma (n=6). Patients were reconstructed with an allograft alone (n=6) or supplemented with an FVF (n=11).

RESULTS

All surviving patients had at least 2 years of clinical follow-up, with the mean follow-up of 12±7 years. The mean time to union of the allograft was 11±4 months, with 6 patients requiring additional bone grafting. There was no difference in the need for an additional bone graft (odds ratio=1.14, P=1.0) between patients with an FVF and those without. Four patients underwent an amputation, all with an allograft alone, due to disease recurrence (n=2) and due to infection (n=2). As such, there was a higher 10-year overall limb-salvage rate when the allograft was combined with an FVF compared with an allograft alone (100% vs. 33%, P=0.001). At last follow-up, the mean Mankin and Musculoskeletal Tumor Society rating was 86%, with a higher mean score in patients reconstructed with an FVF (94% vs. 70%, P=0.002).

CONCLUSION

Use of an intercalary allograft supplemented with an FVF to reconstruct the proximal tibia provides a durable means of reconstruction with an excellent functional outcome following oncologic proximal tibia resection in a pediatric population.

LEVEL OF EVIDENCE

Level III-therapeutic level.

摘要

背景

由于儿童患者的生长潜力和功能需求，胫骨近端的保肢治疗可能较为困难。目前存在多种重建技术，但理想的重建形式仍有待阐明。本研究旨在评估使用同种异体骨进行节段性切除后，再结合或不结合游离腓骨皮瓣（FVF）重建胫骨近端的患者的治疗效果。

方法

17 名儿童患者（9 名男性，8 名女性）在 12±4 岁的平均年龄时，因下肢保肢治疗而接受同种异体尸体骨节段性切除。最常见的诊断是骨肉瘤（n=6）和尤文肉瘤（n=6）。患者采用单纯同种异体骨重建（n=6）或同种异体骨联合 FVF 重建（n=11）。

结果

所有存活患者均获得至少 2 年的临床随访，平均随访时间为 12±7 年。异体骨愈合的平均时间为 11±4 个月，其中 6 例患者需要额外植骨。有 FVF 与无 FVF 的患者在需要额外植骨方面无差异（比值比=1.14，P=1.0）。由于疾病复发（n=2）和感染（n=2），4 名患者接受了截肢，均采用单纯同种异体骨重建。因此，与单纯同种异体骨重建相比，同种异体骨联合 FVF 重建的 10 年总体保肢率更高（100%比 33%，P=0.001）。末次随访时，Mankin 和肌肉骨骼肿瘤学会评分的平均得分为 86%，采用 FVF 重建的患者评分更高（94%比 70%，P=0.002）。