Erwin Uno Surgery, Cahyadi Sigit Daru
Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Dr. Cipto Mangunkusumo Hospital, Indonesia.
Department of Orthopaedic and Traumatology, Faculty of Medicine Universitas Indonesia, Persahabatan General Hospital, Indonesia.
Int J Surg Case Rep. 2021 Dec;89:106568. doi: 10.1016/j.ijscr.2021.106568. Epub 2021 Nov 3.
Osteosarcoma epidemiology in children younger than 5-year-old is very rare. Currently, limb salvage surgery becomes the preferred treatment in osteosarcoma. Wide excision using cryosurgery has been reported as an effective and safe procedure for malignant bone tumors.
A 5-year-old girl was presented with pain and a lump on her right knee. Physical examination showed a solid circumferential mass in the proximal tibia, with limited range of motion due to mass and pain. Osteoblastic lesion with a discrete margin and narrow transition zone on the proximal tibia from plain radiograph and magnetic resonance imaging (MRI) examination. Histopathological examination suggested osteosarcoma with a giant cell rich osteosarcoma subtype. Three cycles of neoadjuvant chemotherapy was conducted with cisplatin, ifosfamide, and adriamycin. We performed limb salvage surgery by wide excision with cryosurgery and vascularized fibular graft reconstruction. Wide excision was performed with the respect to preserve the epiphyseal plate. The proximal tibia segment was recycled using liquid nitrogen and re-implanted, fixed with a locking 2.7 mm T-plate and a straight reconstruction 2.7 mm reconstruction plate. Vascularized fibular graft was used to fill the bone defect on the medial side. Post-operative radiograph showed the plate and screws are well-fixated and the post-operative histopathological examination confirmed the diagnosis of conventional osteosarcoma HUVOS I. There was no post-operative complication observed, and the functional outcome was good.
Cryosurgery and vascularized fibular graft is a viable reconstructive option for proximal tibia osteosarcoma in very young children.
5岁以下儿童骨肉瘤的流行病学情况非常罕见。目前，保肢手术已成为骨肉瘤的首选治疗方法。据报道，使用冷冻手术进行广泛切除是治疗恶性骨肿瘤的一种有效且安全的方法。
一名5岁女孩因右膝疼痛和肿块就诊。体格检查显示胫骨近端有一个实性环形肿块，由于肿块和疼痛导致活动范围受限。X线平片和磁共振成像（MRI）检查显示胫骨近端有一个边界清晰、过渡区狭窄的成骨病变。组织病理学检查提示为骨肉瘤，亚型为富含巨细胞的骨肉瘤。采用顺铂、异环磷酰胺和阿霉素进行了三个周期的新辅助化疗。我们通过冷冻手术广泛切除并进行带血管腓骨移植重建术来实施保肢手术。广泛切除时注意保留骨骺板。使用液氮对胫骨近端节段进行循环处理后重新植入，用锁定2.7毫米T形钢板和直形重建2.7毫米重建钢板固定。使用带血管腓骨移植填充内侧骨缺损。术后X线片显示钢板和螺钉固定良好，术后组织病理学检查确诊为传统型骨肉瘤HUVOS I级。未观察到术后并发症，功能结果良好。
冷冻手术和带血管腓骨移植是极年幼患儿胫骨近端骨肉瘤可行的重建选择。
