Yamamoto Norio, Araki Yoshihiro, Tsuchiya Hiroyuki
Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kanazawa University, 13-1, Takaramachi, Kanazawa-city, Ishikawa, 920-8641, Japan.
Int J Clin Oncol. 2023 Jan;28(1):12-27. doi: 10.1007/s10147-022-02154-4. Epub 2022 Mar 26.
Bone sarcoma often occurs in childhood, as well as in adolescents and young adults (AYAs). AYAs differ from pediatric patients in that their bone is skeletally mature and the physis has almost disappeared with the completion of growth. Although AYAs spend less time outside, they often participate in sports activities, as well as driving, working, and raising a family, which are natural activities in daily living. Multidisciplinary approaches involving imaging, multi-agent chemotherapy, surgical procedures, and careful postoperative care has facilitated an increase in limb-sparing surgery for bone sarcoma. In addition, recent advances in imaging modalities and surgical techniques enables joint-preservation surgery, preserving the adjacent epiphysis, for selected patients following the careful assessment of the tumor margins and precise tumor excision. An advantage of this type of surgery is that it retains the native function of the adjacent joint, which differs from joint-prosthesis replacement, and provides excellent limb function. Various reconstruction procedures are available for joint-preserving surgery, including allograft, vascularized fibula graft, distraction osteogenesis, and tumor-devitalized autografts. However, procedure-related complications may occur, including non-union, infection, fracture, and implant failure, and surgeons should fully understand the advantages and disadvantages of these procedures. The longevity of the normal limb function for natural activities and the curative treatment without debilitation from late toxicities should be considered as a treatment goal for AYA patients. This review discusses the concept of joint-preservation surgery, types of reconstruction procedures associated with joint-preservation surgery, and current treatment outcomes.
骨肉瘤常发生于儿童期，以及青少年和青年成人（AYA）。AYA与儿科患者的不同之处在于，他们的骨骼已发育成熟，随着生长的完成，骨骺几乎消失。尽管AYA户外活动时间较少，但他们经常参加体育活动，以及开车、工作和组建家庭，这些都是日常生活中的正常活动。涉及影像学、多药联合化疗、外科手术及精心术后护理的多学科方法，促进了骨肉瘤保肢手术的增加。此外，影像学检查方式和外科技术的最新进展使得在仔细评估肿瘤边界并精确切除肿瘤后，能够为部分患者实施保留关节的手术，保留相邻骨骺。这类手术的一个优点是保留了相邻关节的天然功能，这与关节假体置换不同，并提供了出色的肢体功能。保留关节手术有多种重建方法可供选择，包括同种异体移植、带血管腓骨移植、牵张成骨和肿瘤灭活自体移植。然而，可能会出现与手术相关的并发症，包括骨不连、感染、骨折和植入物失败，外科医生应充分了解这些手术的优缺点。应将正常肢体功能在自然活动中的长期维持以及无晚期毒性导致衰弱的治愈性治疗视为AYA患者的治疗目标。本综述讨论了保留关节手术的概念、与保留关节手术相关的重建方法类型以及当前的治疗结果。
