Department of Pediatric Orthopedic Surgery, Toulouse University, Children's Hospital, 330 Avenue de la Grande Bretagne, Purpan, Toulouse, 31000, France.
IMFT UMR CNRS 5502, Toulouse University, Purpan, Toulouse, France.
Int Orthop. 2024 Nov;48(11):3003-3014. doi: 10.1007/s00264-024-06313-2. Epub 2024 Sep 12.
The aim of this study was to report on mid- to long-term results following large humeral tumoral resection and reconstruction with the induced-membrane technique in skeletally immature patients suffering from primary malignant bone tumours.
A retrospective analysis identified all children who underwent the two stages of a humeral reconstruction using the induced-membrane technique for primary malignant humerus tumours between 2002 and 2020. Functional assessment was conducted by an independent observer using the Musculoskeletal Tumor Society (MSTS) scoring system for the upper limb. Radiological assessment was performed by two independent observers and the healing index was calculated (i.e., months/cm).
Eight adolescents (5 osteosarcomas and 3 Ewing sarcoma), with a mean age of 14.2 years (SD = 2.7), were included. The mean length of the bone resection was 17.4 cm (SD = 3.8), and the mean delay of the resection and reconstruction stages was 9.4 months (SD = 4). The mean follow-up was 6.6 years (SD = 4.3). The mean MSTS score was 77.4% and the global average healing index was 1.04 months/cm (SD = 2.2). Four complications (i.e., prominence device, fracture, aseptic pseudarthrosis, radial palsy) and one local recurrence were observed in four patients, requiring four unplanned surgical procedures in three patients. One patient died fourteen years after the initial treatment due to a lung recurrence.
The induced-membrane technique is an effective and safe alternative for reconstructing large humeral bone defects after tumour resection in adolescents. Although this is a two-stage technique, it gives good functional results comparable to other strategies found in the literature.
IV.
本研究旨在报告采用诱导膜技术对患有原发性恶性骨肿瘤的骨骼未成熟患者进行大肱骨肿瘤切除和重建后的中期至长期结果。
回顾性分析确定了 2002 年至 2020 年间采用诱导膜技术对原发性恶性肱骨肿瘤进行两阶段肱骨重建的所有儿童。采用肌肉骨骼肿瘤学会（MSTS）上肢评分系统对功能进行独立观察者评估。对两位独立观察者进行影像学评估，并计算愈合指数（即，月/cm）。
纳入 8 名青少年（5 例骨肉瘤和 3 例尤文肉瘤），平均年龄 14.2 岁（SD=2.7）。骨切除的平均长度为 17.4cm（SD=3.8），切除和重建阶段的平均延迟为 9.4 个月（SD=4）。平均随访时间为 6.6 年（SD=4.3）。平均 MSTS 评分为 77.4%，整体平均愈合指数为 1.04 个月/cm（SD=2.2）。4 名患者（即突出装置、骨折、无菌假关节、桡神经麻痹）出现 4 种并发症，3 名患者中有 1 名患者需要进行 4 次计划外手术。1 名患者在初始治疗后 14 年因肺部复发死亡。
在青少年中，诱导膜技术是肿瘤切除后重建大肱骨骨缺损的有效且安全的替代方法。尽管这是一种两阶段技术，但它提供了与文献中其他策略相当的良好功能结果。
IV。
