| ObjectiveA short-term clinical study of the treatment of children with distal femur type san-julian ? osteosarcoma using extended rotatable hinged tumor knee prosthesis with tibial epiepiseal retention was conducted to evaluate the safety and efficacy of this procedure.MethodsFrom October 2017 to April 2020,all children were confirmed to have osteosarcoma by biopsy pathology in our hospital.Preoperative neoadjuvant chemotherapy for 1 to 2 cycles(chemotherapy regimen:adriamycin+cisplatin+ifosfamide+high-dose methotrexate;Method of administration:intravenous systemic chemotherapy.After neoadjuvant chemotherapy,DR,CT,MRI and radionuclide bone scan were used to evaluate the sensitivity of chemotherapy and determine the distant metastasis.According to preoperative imaging examination,a total of 6 children with type SAN-Julian ? common osteosarcoma of distal femur were screened out without distant metastasis,including 2 males and 4 females.The age ranges from 7 to 12 years,with an average age of about 10 years.On the left side of the 3 cases,right 3 cases,preoperative by American Society for bone tumors scoring system(Musculoskeletal Tumor Society,MSTS)in lower extremity function score is 9?15 points,scored an average of 13 points,Enneking stage are ? B,used in our hospital to complete keep tibial epiphyseal extension of the rotating hinge knee type Tumor prosthesis revascularization,intraoperative using knee extracapsular resection,postoperative children with guidance function of exercise,take out stitches wound in 14?20 days,remove to the standardization of the postoperative chemotherapy after 1 week,Patients were followed up every 3 months after surgery,including limb X-ray,lung CT and radionuclide bone scan,limb MSTS function score,limb mobility and limb length difference,etc.ResultsThe operation time of the 6 children was 2.5h,3h,3h,3.2h,3.5h and 4h,respectively,with an average of 3.2h.Intraoperative blood loss was 600?1200ml,with an average of 850ml.The follow-up time of 6 children patients was 18?30 months,and the average follow-up time was 25 months.According to the MSTS score criteria,the lower limb function score in the last follow-up was 18-27 points,with an average score of 23 points.According to the score results,the limb function of the children reached the good standard.In the last follow-up,there were 4 patients with knee joint flexion Angle of 90?110 degrees and 2 patients with knee joint flexion Angle of 110?130 degrees.In 5 cases,the comparative shortening of the affected and healthy limbs was no more than 1.5cm,and in 1 case,the comparative shortening of the affected and healthy limbs was about 2cm.5 cases of postoperative wound healing,take out stitches after 14 days,1 case of postoperative 12 days appear superficial skin split open wound,ca.2 cm long,visible on the surface of a small amount of light yellow thin secretions,disinfected after discharge from the wound for bacterial culture and drug susceptibility test,at the same time,broad-spectrum antibiotics for anti-infection treatment and timely to wounds superficial skin split disinfected,replace sterile dressings,restriction on limb joint activities,partial use roast lamp to promote healing.The bacterial culture results were negative.After about 1 week,the cracked skin was successfully healed and stitches were removed.There were no complications such as infection,loosening and fracture and periprosthesis fracture during the follow-up period.ConclusionsBy preoperative imaging studies,review of distal femur Enneking installment and San-Julian parting,strictly grasp the indications,mediator limb this study method using retain tibial epiphyseal can prolong spin false hinged knee tumor weight was built long bone defects,in the knee joint way extracapsular resection for San-Julian ? distal femur osteosarcoma invasion of epiphyseal provides a safe and effective in children with limb salvage treatment. |
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