Long-term follow-up after limb salvage in skeletally immature children with a primary malignant tumor of the distal end of the femur
Long-term follow-up after limb salvage in skeletally immature children with a primary malignant tumor of the distal end of the femur
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DOI：
10.2106/jbjs.c.01686
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发表时间：
2006-03-01
影响因子：
5.3
通讯作者：
Ueda, T
中科院分区：
文献类型：
--
作者：
Futani, H;Minamizaki, T;Ueda, T
背景：在股骨远端有原发性恶性肿瘤的骨骼发育不成熟的儿童是肢体保留手术的候选人；然而，由于随后的肢体长度差异导致的功能损害必须考虑在内。我们的目的是评估11岁或以下的股骨远端肉瘤患者肢体保留的长期临床结果，重点关注肢体长度差异和并发症。方法：对40例儿童进行多中心回顾性分析。28例患者进行了假体内重建，12例进行了生物重建。功能评估基于肌肉骨骼肿瘤协会评分系统，以下六个类别中的每一个都有0到5分的数值：疼痛、功能、情感接受、支持的使用、行走能力和步态。将这些值相加，并将功能分数表示为最大可能分数的百分比。用正位图测量四肢长度差异。分析并发症及处理方法。采用Kaplan-Meier法分析患者生存和重建的生存。结果：术后10年生存率82%，死亡7例，存活33例。对于存活的患者，22例假体内重建患者（13.2 +/- 3.9年）和11例生物重建患者（10.4 +/- 4.4年）的平均随访时间（和标准差）相似。所有患者均达到骨骼成熟。最终功能评分的平均值，假体内重建组为74% +/- 18%，生物重建组为68% +/- 17% （p = 0.37）。对于19例接受肢体延长的患者，平均功能评分从手术前的65% +/- 21%显著增加到延长后的81% +/- 11% （p = 0.0016）。早期并发症5例，晚期并发症28例。在假体内重建组中，最常见的并发症是深度感染和无菌性松动。在生物重建组，最常见的并发症是种植体断裂和不愈合。17名患者需要进行修复手术，其中包括5名截肢患者。术后5年和10年假体重建的存活率分别为77%和51%，而术后5年和10年生物重建的存活率分别为46%。结论：对于患有股骨远端恶性骨肿瘤的骨骼发育不成熟的儿童，尽管进行了高比率的修复和肢体延长手术，但假体或生物重建作为肢体保留提供了良好的功能结果。
Background: Skeletally immature children with a primary malignant tumor in the distal end of the femur are candidates for limb-salvage surgery; however, functional impairment due to subsequent limb-length discrepancy must be considered. Our aim was to evaluate the long-term clinical outcome of limb salvage in patients with a sarcoma of the distal end of the femur who were eleven years old or less, focusing on limb-length discrepancy and complications.Methods: The cases of forty children were retrospectively reviewed in a multicenter study based on the responses to a questionnaire. Twenty-eight patients had had endoprosthetic reconstruction, and twelve had had biological reconstruction. Functional evaluation was based on the Musculoskeletal Tumor Society scoring system, with numerical values from 0 to 5 points assigned for each of the following six categories: pain, function, emotional acceptance, use of supports, walking ability, and gait. These values were added, and the functional score was presented as a percentage of the maximum possible score. Limb-length discrepancy was measured with orthoroentgenograms. Complications and their treatment were analyzed. Patient survival and the survival of the reconstructions were analyzed with use of the Kaplan-Meier method.Results: Seven patients died and thirty-three remained alive, for a survival rate of 82% at ten years postoperatively. For the surviving patients, the mean follow-up periods (and standard deviations) were similar for the twenty-two who had endoprosthetic reconstruction (13.2 +/- 3.9 years) and the eleven who had biological reconstruction (10.4 +/- 4.4 years). All patients had reached skeletal maturity. The mean final functional score was 74% +/- 18% in the endoprosthetic reconstruction group and 68% +/- 17% in the biological reconstruction group (p = 0.37). For the nineteen patients who underwent limb-lengthening, the mean functional score increased significantly from 65% +/- 21% before the procedure to 81% +/- 11% after the lengthening (p = 0.0016). There were five early and twenty-eight late complications. In the endoprosthetic reconstruction group, the most frequent complications were deep infection and aseptic loosening. In the biological reconstruction group, the most frequent complications were implant breakage and nonunion. Revision surgeries were required in seventeen patients, including five who had an amputation. The rate of survival of the endoprosthetic reconstructions was 77% at five years and 51% at ten years postoperatively, whereas the rate of survival of the biological reconstructions was 46% at both five and ten years postoperatively.Conclusions: Endoprosthetic or biological reconstructions as limb salvage provided good functional outcome in skeletally immature children with a malignant bone tumor of the distal aspect of the femur despite a high rate of revisions and limb-lengthening procedures.