El Ghoneimy Ahmed, Zaky Imane, Zamzam Manal, Kamel Ahmed, Mounir Nada, El Kenaey Naglaa
Children Cancer Hospital 57357, Cairo, Egypt; Cairo University, Cairo, Egypt.
Children Cancer Hospital 57357, Cairo, Egypt; National Cancer Institute, Cairo, Egypt.
J Hand Surg Am. 2022 Oct;47(10):1017.e1-1017.e7. doi: 10.1016/j.jhsa.2021.08.007. Epub 2021 Sep 30.
Primary malignant bone tumors of the hand are rare in children. Resection and reconstruction of the digit are challenging and have been described in case reports. This retrospective study describes the functional and oncologic outcomes of resection and reconstruction using a nonvascularized fibular bone graft in a cohort of children.
A total of 5 children were included. The mean age at diagnosis was 7.6 years (range, 1.6-12 years). Histologic diagnosis showed Ewing sarcoma in 3 and osteosarcoma in 2 patients. Four tumors were located in the metacarpal bones of the fingers, and 1 was located in the thumb. Four patients were treated with chemotherapy. All the patients were treated with wide resection and a cement spacer. This was followed by second stage reconstruction using a nonvascularized fibular bone graft. In tumors of the fingers, carpometacarpal joint fusion with a neighboring carpal bone was performed, whereas a pseudoarthrosis was created between the graft and the base of the proximal phalanx. In the thumb's case, the opposite was done, with fusion at the metacarpophalangeal joint and a pseudoarthrosis at the carpometacarpal joint.
The mean follow-up duration was 5.5 years (range, 2-9 years). Surgical margins were negative in all the patients. At their latest follow-up visit, none of the patients developed systemic or local recurrence. Two complications required a revision surgery, one due to graft subluxation and the other due to nonunion. At their final follow-up examination, the mean total arc of movement was 80° (range, 60°-100°), and all the patients were able to resume their grasping and writing capabilities.
The resection and reconstruction of primary malignant bone tumors of the metacarpals using a nonvascularized fibular bone graft in children can preserve the cosmesis and function of the digit without jeopardizing oncologic outcomes.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic V.
儿童手部原发性恶性骨肿瘤较为罕见。手指的切除与重建具有挑战性，已有病例报告对此进行过描述。这项回顾性研究描述了在一组儿童中使用非血管化腓骨骨移植进行切除与重建的功能和肿瘤学结果。
共纳入5名儿童。诊断时的平均年龄为7.6岁（范围1.6 - 12岁）。组织学诊断显示3例为尤因肉瘤，2例为骨肉瘤。4个肿瘤位于手指掌骨，1个位于拇指。4例患者接受了化疗。所有患者均接受了广泛切除及骨水泥间隔物植入。随后进行二期重建，使用非血管化腓骨骨移植。对于手指肿瘤，将掌指关节与相邻腕骨融合，而在移植骨与近端指骨基部之间形成假关节。对于拇指肿瘤，则进行相反操作，即掌指关节融合，腕掌关节形成假关节。
平均随访时间为5.5年（范围2 - 9年）。所有患者手术切缘均为阴性。在最近一次随访时，所有患者均未出现全身或局部复发。有2例并发症需要进行翻修手术，1例是由于移植骨半脱位，另1例是由于骨不连。在最后一次随访检查时，平均总活动弧为80°（范围60° - 100°），所有患者均能够恢复抓握和书写能力。
在儿童中使用非血管化腓骨骨移植对手部原发性恶性骨肿瘤进行切除与重建，可保留手指的美观和功能，而不影响肿瘤学结果。
研究类型/证据水平：治疗性研究V级
