Department of Orthopedic Oncology Surgery, Beijing Jishuitan Hospital, Capital Medical University, No.31 Xin Jie Kou East Street, Xi Cheng District, Beijing, 100035, China.
J Orthop Surg Res. 2024 Oct 3;19(1):619. doi: 10.1186/s13018-024-05103-1.
Treatment options for correcting limb-length discrepancy after limb-salvage reconstruction for proximal tibial osteosarcoma in children have several limitations. Therefore, we aimed to evaluate the feasibility, complications, prognosis, and clinical outcomes of reconstruction using hemiarthroplasty after tumor resection in pediatric patients with proximal tibial osteosarcoma.
We conducted a comprehensive retrospective analysis of the data of pediatric patients with osteosarcoma of the proximal tibia who underwent surgery between December 2008 and November 2018 at our center. We enrolled 49 consecutive patients who underwent hemiarthroplasty. The cruciate ligaments of all patients were reconstructed using special spacers, and the medial and lateral collateral ligaments of the knee and joint capsule were reconstructed using a mesh. Postoperatively, if the unequal length of both lower limbs exceeded 4 cm or knee instability occurred, a second-stage surgery was performed for limb lengthening and replacing the distal femoral prosthesis. We analyzed the oncological prognosis, complications of hemiarthroplasty, postoperative stability, and postoperative function.
The follow-up period ranged between 11 and 159 months, with a median of 84 (62, 129) months. The overall 5-year survival rate was 83.2%. Thirty-nine patients survived at the end of the follow-up period with 34 prostheses (87.2%). The overall prosthesis survival rate was 87.4% after 5 years, indicating the long-term benefits of the procedure. Limb length was measured in 28 adult patients. The average limb-length discrepancy was 33 ± 15 mm with a median of 33 mm (21, 47); the femur and tibia caused a discrepancy of 8.5 ± 9.9 mm and 24.8 ± 15.5 mm, respectively. The patients had 30-135° of knee motion, with a mean of 82 ± 24°. The femoral tibial angle was greater on the affected side than on the healthy side, with a mean difference of 4.5°±3.6°. The Musculoskeletal Tumor Society (MSTS) score was 25 ± 3. Five patients underwent second-stage distal femoral prosthesis replacement, with mean MSTS scores of 24 ± 2 and 28 ± 1 before and after second-stage surgery, respectively.
Hemiarthroplasty in children reduces limb-length discrepancy in adulthood by rebuilding cruciate ligaments, lateral collateral ligaments, and the joint capsule, thereby improving knee stability.
对于儿童保肢治疗后近端胫骨骨肉瘤肢体长度差异的矫正，治疗方案存在多种局限性。因此，我们旨在评估肿瘤切除后使用半关节成形术重建在儿童近端胫骨骨肉瘤患者中的可行性、并发症、预后和临床结果。
我们对 2008 年 12 月至 2018 年 11 月在我们中心接受手术的近端胫骨骨肉瘤患儿进行了全面的回顾性数据分析。我们纳入了 49 例连续接受半关节成形术的患者。所有患者的十字韧带均使用特殊间隔物重建，膝关节的内外侧副韧带和关节囊使用网片重建。术后，如果双侧下肢不等长超过 4cm 或出现膝关节不稳定，行二期手术进行肢体延长和更换股骨远端假体。我们分析了骨肉瘤的预后、半关节成形术的并发症、术后稳定性和术后功能。
随访时间为 11 至 159 个月，中位数为 84（62，129）个月。整体 5 年生存率为 83.2%。39 例患者在随访结束时存活，其中 34 例假体仍在使用（87.2%）。5 年后假体整体生存率为 87.4%，表明该手术具有长期获益。28 例成人患者进行了肢体长度测量。平均肢体长度差异为 33±15mm，中位数为 33mm（21，47）；股骨和胫骨分别导致 8.5±9.9mm 和 24.8±15.5mm 的差异。患者的膝关节活动度为 30-135°，平均为 82°±24°。患侧股骨胫骨角大于健侧，平均差异为 4.5°±3.6°。肌肉骨骼肿瘤学会（MSTS）评分为 25±3。5 例患者行二期股骨远端假体置换术，二期手术前后 MSTS 评分分别为 24±2 和 28±1。
儿童半关节成形术通过重建十字韧带、外侧副韧带和关节囊，减少了成年后的肢体长度差异，从而改善了膝关节的稳定性。
