Custom-made semi-joint prosthesis replacement combined ligament advanced reinforcement system (LARS) ligament reconstruction for the limb salvage surgery of malignant tumors in the distal femur in skeletal immature children.
Custom-made semi-joint prosthesis replacement combined ligament advanced reinforcement system (LARS) ligament reconstruction for the limb salvage surgery of malignant tumors in the distal femur in skeletal immature children.
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DOI：
10.3389/fped.2023.1168637
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发表时间：
2023
影响因子：
2.6
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中科院分区：
文献类型：
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探讨定制半关节假体置换联合韧带高级强化系统（LARS）韧带重建在股骨远端恶性肿瘤保肢手术（LSS）中的应用，为骨骼发育不成熟儿童恶性肿瘤保肢手术提供选择。回顾性招募2018年1月至2019年12月在我院骨软组织肿瘤中心行定制半关节假体置换术联合LARS韧带重建术治疗LSS的股骨远端恶性肿瘤患儿8例。观察假体相关并发症、肿瘤预后及膝关节功能，综合评价手术疗效。平均随访时间36.6个月（30 ~ 50个月）。根据术前影像学结果和定制假体长度，平均截骨长度为13.2 cm （8-20 cm）。术后2年MSTS-93平均评分为24.4分（16-29分），提示肢体功能良好。膝关节活动范围为0°-120°，最大平均为100°。最后随访时，患儿平均身高增加8.4 cm (6 ~ 13 cm)，肢体平均缩短2.7 cm （1.8 ~ 4.6 cm）。1例患者术后早期出现创面并发症，创面痂脱落形成浅表溃疡，行清创缝合。1例患者术后2年发生假体血液性播散感染，现假体原位抗感染治疗。1例患者随访期间发生肺转移，术后接受化疗及靶向治疗，病灶控制良好。在最后一次随访中，没有局部肿瘤复发或假体松动。在病例选择合适的前提下，定制化半关节假体置换联合LARS韧带重建为儿童股骨远端恶性肿瘤LSS提供了新的选择。LARS韧带重建保证了膝关节的稳定性和活动范围，最大限度地保留了胫骨侧骨骺和胫骨侧生长功能，减少了长期肢体长度不均等的并发症，为成人肢体延长或全关节置换术创造了条件。
To explore the application of Custom-made Semi-joint prosthesis replacement combined with Ligament Advanced Reinforcement System (LARS) ligament reconstruction for the limb salvage surgery (LSS) of malignant tumors in the distal femur and provide selections for the LSS of malignant tumors in skeletal immature children. A total of 8 children with malignant tumors in the distal femur who underwent Custom-made Semi-joint prosthesis replacement combined LARS ligament reconstruction for LSS from January, 2018 until December, 2019 in our bone and soft tissue tumor center were retrospectively recruited. The prosthesis related complications, oncological prognosis and knee function were observed, and the surgical efficacy was comprehensively evaluated. The average follow-up time was 36.6 months (30–50 months). The average osteotomy length was 13.2 cm (8–20 cm) according to the preoperative imaging results and the length of the customized prosthesis. Two years after operation, the average MSTS-93 score was 24.4 (16–29) which indicated good limb functions. The range of motion of the knee was 0°–120°, with an maximum average of 100°. At last follow-up, the average height of the children increased by 8.4 cm (6–13 cm), and the average limb shortening was 2.7 cm (1.8–4.6 cm). One patient had wound complications in the early postoperative period, wound scab fell off to form superficial ulcer, in whom debridement and suturing were performed. One patient developed hematogenous disseminated prosthesis infection 2 years after surgery, and the prosthesis is now in situ with anti-infection treatment. One patient developed pulmonary metastasis during follow-up, and received chemotherapy and targeted therapy with lesion well controlled. At the last follow-up, there was no local tumor recurrence or prosthesis loosening. Under the premise of appropriate case selection, customized semi-joint prosthesis replacement combined with LARS ligament reconstruction provides a new option for LSS in children with distal femur malignant tumors. LARS ligament reconstruction ensures the stability and range of motion of the knee joint, which maximally preserves the epiphysis of the tibia side and the growth function of the tibia side, reduces the complications of limb length inequality in the long term and creates conditions for limb lengthening or total joint replacement in adults.
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影响因子：
2.7
作者：
Torner, Ferran;Segur, Josep M.;Knorr, Jorge
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3.2
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