Durrani Muhammad Younus Khan, Ali Usman, Saeed Javeria, Umer Masood
Orthopaedic Surgery, Aga Khan University Hospital, Karachi, PAK.
Cureus. 2024 Nov 28;16(11):e74672. doi: 10.7759/cureus.74672. eCollection 2024 Nov.
Background Managing primary bone and soft tissue sarcomas in pediatric patients poses significant challenges, with surgical resection remaining essential for cure. While limb salvage surgery has emerged as the standard approach, concerns persist regarding post-operative complications. Our study aims to evaluate the 30-day morbidity and mortality of limb salvage surgery in pediatric tumor patients, bridging critical knowledge gaps and contributing to enhancing the standard of care in low- and middle-income countries (LMICs). Materials and methods A prospective cohort study was conducted on pediatric patients (aged 18 years or younger) who presented at a tertiary care hospital's orthopedics department and required limb salvage surgery due to various tumors from May 2021 to October 2023. Results Nineteen cases met the inclusion criteria. The average patient age was 12.2 years (SD = 4.71), with 5 (20.8%) females and 14 (79.2%) males. Bone tumors accounted for 12 (63.2%) cases, and soft tissue tumors for 7 (36.8%). Osteosarcoma was the most common tumor (36.8%), followed by Ewing Sarcoma (31.57%) and Synovial Sarcomas (15.8%). Free fibular grafts were used in 6 (31.6%) cases, and Mega prosthesis in 3 (15.8%). Overall, 26.3% of cases experienced post-surgical complications within 30 days, notably including surgical site infections (21.05%) and flap necrosis (10.53%). No significant differences in demographic and clinical variables were observed between patients with and without complications. Conclusion Our study highlights immediate post-operative outcomes and complications of limb salvage surgery in pediatric musculoskeletal tumor patients, particularly in LMIC settings. Despite advancements, early complications remain challenging, with nearly one-quarter of patients experiencing adverse events within 30 days. The prevalence of surgical site infections emphasizes the urgent need for improved infection control measures in LMICs.
背景 管理小儿原发性骨和软组织肉瘤面临重大挑战，手术切除仍是治愈的关键。虽然保肢手术已成为标准方法，但对术后并发症的担忧依然存在。我们的研究旨在评估小儿肿瘤患者保肢手术的30天发病率和死亡率，填补关键知识空白，并有助于提高低收入和中等收入国家（LMICs）的护理标准。
材料和方法 对2021年5月至2023年10月在一家三级护理医院骨科就诊、因各种肿瘤需要保肢手术的18岁及以下小儿患者进行了一项前瞻性队列研究。
结果 19例符合纳入标准。患者平均年龄为12.2岁（标准差=4.71），女性5例（20.8%），男性14例（79.2%）。骨肿瘤占12例（63.2%），软组织肿瘤占7例（36.8%）。骨肉瘤是最常见的肿瘤（36.8%），其次是尤因肉瘤（31.57%）和滑膜肉瘤（15.8%）。6例（31.6%）使用了游离腓骨移植，3例（15.8%）使用了大型假体。总体而言，26.3%的病例在30天内出现术后并发症，主要包括手术部位感染（21.05%）和皮瓣坏死（10.53%）。有并发症和无并发症的患者在人口统计学和临床变量上未观察到显著差异。
结论 我们的研究强调了小儿肌肉骨骼肿瘤患者保肢手术的术后即时结果和并发症，特别是在LMIC环境中。尽管取得了进展，但早期并发症仍然具有挑战性，近四分之一的患者在30天内出现不良事件。手术部位感染的发生率强调了LMICs迫切需要改进感染控制措施。
