Babin S R, Simon P, Babin-Boilletot A, Bellocq J P, Marcellin L, Dosch J C
Service de Traumatologie, Hôpital de Hautepierre, CHU de Strasbourg.
Rev Chir Orthop Reparatrice Appar Mot. 1996;82(1):14-21.
Over 11 years we treated 30 osteosarcomas: 20 of them were high grade non metastatic osteosarcomas of the lower limb, which were treated by neoadjuvant chemotherapy (Rosen T10, or OS 87 protocol of the French Society for Pediatric Oncology).
There were 12 males and 8 females; the mean age was 19 years (range 12-51). The site of the tumor was the femoral neck (1 case), femoral diaphysis (2 cases), distal femur (12 cases), proximal tibia (4 cases), distal tibia (1 case), 3 were IIA and 17 IIB according to Enneking system. Conservative treatment was performed in 17 cases: there were 12 knee prostheses, 4 allografts and 1 knee arthrodesis with allograft.
a) Surgical complications: Mechanical complications occurred in 10 patients. The function was preserved 8 times. In 2 patients the knee became stiff. An infection occurred in 3 patients: a conservative treatment was possible in 2 of them with a fair result. In the third case, an above-the-knee amputation had to be done. b) Functional results were studied according to Enneking rating. 14 arthroplasties (12 done as first surgical treatment and 2 after mechanical complication) had a 68, 19 score. c) Oncologic results: 8 patients were good respondents and 12 patients were bad respondents to chemotherapy according to Huvos grading. One local relapse was observed which could be treated by mean of a second chemotherapy and a prosthetic reconstruction. The patient is still alive and disease-free at 7 years (9 years after the diagnosis of the osteosarcoma). 5 patients had distant metastasis (lung, bones, and brain). One out of 5 was good respondent and 4 out of 5 are presently dead. Using Kaplan Meier statistical analysis, the overall survival wzs 76.8 per cent and the event-free survival was 67.4 per cent at 80 months.
We preferred a simple prosthetic reconstruction without osseous sleeve or an intercalary allograft if possible: these procedures allow the patient very rapid autonomy to have despite a prolonged chemotherapy.
在11年多的时间里，我们治疗了30例骨肉瘤：其中20例为下肢高级别非转移性骨肉瘤，采用新辅助化疗（罗森T10方案，或法国儿科肿瘤学会的OS 87方案）进行治疗。
男性12例，女性8例；平均年龄19岁（范围12 - 51岁）。肿瘤部位为股骨颈（1例）、股骨干（2例）、股骨远端（12例）、胫骨近端（4例）、胫骨远端（1例），根据恩内金系统，3例为IIA期，17例为IIB期。17例患者接受了保肢治疗：其中12例进行了膝关节置换，4例进行了异体骨移植，1例进行了异体骨膝关节融合术。
a）手术并发症：10例患者出现机械性并发症。8次保留了功能。2例患者膝关节僵硬。3例患者发生感染：其中2例可行保守治疗，效果尚可。第3例患者不得不进行膝上截肢。b）根据恩内金评分研究功能结果。14例关节成形术（12例作为首次手术治疗，2例在机械性并发症后进行）的评分为68.19分。c）肿瘤学结果：根据胡沃斯分级，8例患者对化疗反应良好，12例患者反应不佳。观察到1例局部复发，可通过再次化疗和假体重建进行治疗。该患者在7年时（骨肉瘤诊断后9年）仍存活且无疾病。5例患者发生远处转移（肺、骨和脑）。5例中有1例反应良好，5例中有4例目前已死亡。使用卡普兰 - 迈耶统计分析，80个月时总生存率为76.8%，无事件生存率为67.4%。
如果可能，我们倾向于采用简单的假体重建，不使用骨袖或间置异体骨：这些手术方法可使患者在接受长时间化疗的情况下仍能很快恢复自主活动。
