【摘要】 目的　探讨特制半关节假体置换用于儿童膝关节恶性骨肿瘤的效果。方法　1999年至 2002年底,对17例膝关节周围恶性肿瘤的儿童进行了半关节假体置换。其中胫骨上端8例,股骨下端9 例。骨肉瘤11例,尤文肉瘤6例。手术时的年龄为8～13岁,病变范围6～13cm。所有患者进行术前穿刺 活检以明确诊断。均进行常规术前检查,并保证规范的化疗。术前根据平片、CT和MRI等确定病变范围, 测量关节大小,设计半关节假体,假体略长于截骨段1～2cm。假体设有重建髌韧带及侧副韧带的孔洞,并 可植骨,生物重建髌韧带及双侧副韧带。术后石膏外固定6～8周,之后支具保护,限制活动,关节屈伸度 在0～60度以内,锻炼相关肌肉的功能,并同时进行术后规范化疗。结果　随访8～42个月,所有患者均成 功地进行了半关节假体置换,保留关节对侧正常骨骺。除2例患儿分别在术后12个月和36个月死于肺转 移外,其余患者均可在支具保护下行走,膝关节活动范围在60度以内,对患肢功能均感到满意。6例患者 随访超过3年,其身高增加了6～11cm,患肢短缩2.6～4.8cm。仅有1例局部复发,再行肿瘤切除术。2例 患者并发皮肤坏死,经清创和皮瓣移植后愈合。1例出现骨折,经石膏外固定后愈合。1例外伤后膝关节 脱位,行手术复位。已有2例行再次手术延?更多还原

【Abstract】 Objective As most primary bone malignant tumors in children are located around the knee and resection of the physes in a patient who is skeletally immature often results in limb length discrepancy. We designed the semi-joint prosthesis to reconstruct the knee joint in these patients. Methods From 1999 to 2002, 17 children with malignant tumors around the knee were underwent custom-made semi-joint prostheses replacement. The children’s age ranged from 8 to 13 years. The diseases are osteosarcoma in 11 and Ewing sarcoma 6. The tumor located at distal femur 9 and proximal tibia 8. The affected limb was lengthened 1-2cm and the main ligaments attachments were reconstructed. Results All of these 17 patients’ surgery were successful and the opposite epiphysis was undamaged. 2 patients had a skin flap necrosis and the wounds healed up after a simple debridement and a local flap grafting. Trauma-caused dislocation occurred in 1 patient 9 months after surgery and the joint was reduced successfully by operation. 2 patients with osteosarcoma died of systemic relapse 12 and 36 months after surgery respectively. The height of the 6 patients increased 6-11cm and the affected limbs shortened 2.6-4.8cm after three-years-followed-up. Discrepancy had been corrected by a second surgery in some of the patients. Conclusion The semi-joint prostheses used in the limb-sparing surgery of the children’s malignant tumors around the knee have the advantages of avoiding injury of the opposite epiphysis, providing strong support, stabilizing the joint and facilitating elongation of the affected limb in the future. Moreover, Partial function of the knee was reserved.更多还原