Department of Orthopaedic Surgery, IRCCS Rizzoli Institute, Via Pupilli n1, 40136, Bologna, Italy.
Eur J Orthop Surg Traumatol. 2021 Dec;31(8):1577-1582. doi: 10.1007/s00590-021-02995-1. Epub 2021 May 19.
Reconstruction of the distal femur in children following resection of bone sarcoma is challenging. The main problem in children is the small size of bone and a possible limb-length discrepancy at the end of skeletal growth secondary to the loss of the physes. We reported the results of a new surgical technique for distal femur reconstruction after bone tumor resection in children.
We analyzed 5 patients with distal femoral sarcomas who underwent intra-articular resection and reconstruction with resurfaced allograft-prosthetic composite at a mean follow-up of 70 months. There were 2 males and 3 females, with a mean age of 10 years (range 8-12) at the time of the diagnosis. All patients were affected by high-grade osteosarcoma. The patients' medical records were reviewed for clinical and functional outcomes as well as post-operative complications. The functional evaluation of the patients was done at the end of the follow-up using Musculoskeletal Tumor Society scoring system. The minimal follow-up was 24 months.
At the last follow-up, 4 patients were continuously disease-free. We excluded one patient who died of disease secondary to lung metastases 16 months after the surgery. Complications occurred in 2 of 4 patients at 17 months and 24 months, respectively. One patient developed deep infection who required the removal of the original reconstruction and, once the infection was treated, the patient underwent reconstruction with an expandable prosthesis. An allograft fracture occurred in another of the 4 patients at 24 months after the first surgery, thus the original reconstruction was removed and the patient underwent reconstruction with modular prosthesis. In the two patients who retained the original reconstruction at the time of their latest follow-up, the mean implant survival time was 70 months. These patients had an excellent MSTS score (29.5 points) and walked without support or limitations with an active knee range of motion of > 90° and complete active extension of the knee. No degenerative changes of the articular surface of the proximal tibia and the patella were observed at the time of the last follow-up. Growth of the physis of the proximal tibia was observed in all the patients during follow-up and no angular deformity of the joint was observed. The limb discrepancy was 4 cm and 2 cm, respectively.
Resurfaced allograft-prosthetic composite may represent an alternative surgical technique for distal femur reconstruction in children with bone sarcomas. Although its success is limited by high risk of complications, resurfaced allograft-prosthetic composite seems to be a viable option to preserve the bone stock and the physis of the proximal tibia in selected young patients, minimizing a potential limb-length discrepancy at the end of the skeletal growth.
儿童骨肉瘤切除后，远端股骨的重建极具挑战性。对于儿童来说，主要问题是骨骼较小，并且由于骺板的丢失，可能会在骨骼生长结束时导致肢体长度出现差异。我们报告了一种用于儿童骨肿瘤切除后远端股骨重建的新手术技术的结果。
我们分析了 5 例接受关节内切除和覆盖异体骨-假体复合重建的儿童股骨远端肉瘤患者，平均随访 70 个月。2 例为男性，3 例为女性，诊断时平均年龄为 10 岁（8-12 岁）。所有患者均患有高级别骨肉瘤。对患者的临床和功能结果以及术后并发症进行了病历回顾。在随访结束时，使用肌肉骨骼肿瘤学会评分系统对患者进行功能评估。最小随访时间为 24 个月。
在最后一次随访时，4 例患者持续无病。我们排除了 1 例术后 16 个月因肺转移而死亡的患者。4 例中有 2 例分别在 17 个月和 24 个月时发生并发症。1 例发生深部感染，需要取出原重建物，感染得到治疗后，患者接受了可膨胀假体重建。另 1 例在初次手术后 24 个月时发生异体骨骨折，因此取出原重建物，患者接受了模块化假体重建。在 2 例保留原重建物的患者中，平均植入物存活率为 70 个月。这些患者的肌肉骨骼肿瘤学会评分（29.5 分）极好，膝关节活动度大于 90°，完全主动伸展，行走无需支撑或限制。在最后一次随访时，未观察到近端胫骨和髌骨关节面的退行性改变。所有患者在随访期间观察到近端胫骨骺板生长，未观察到关节角度畸形。肢体差异分别为 4cm 和 2cm。
覆盖异体骨-假体复合可能是儿童骨肉瘤远端股骨重建的一种替代手术技术。尽管其成功受到并发症高风险的限制，但覆盖异体骨-假体复合似乎是一种可行的选择，可以在选定的年轻患者中保留胫骨近端的骨量和骺板，最大限度地减少骨骼生长结束时肢体长度差异的潜在风险。
