Short-term clinical efficacy of artificial mesh combined with hemiarthroplasty in the treatment of malignant primary bone tumors involving the epiphysis around the knee joint of children
Abstract：Objective This study aimed to explore the short-term clinical efficacy of an artificial patch combined with hemiarthroplasty in the treatment of primary bone malignant tumors involving the epiphysis around the knee joint in children. Methods This was a case series report. Eight patients with primary bone malignant tumors around the knee joint who were admitted to the Department of Bone Tumor Surgery, the First Affiliated Hospital of Xinjiang Medical University, from June 2019 to March 2022 were included, including four males and four females, aged 8-13 (10.6±1.6) years, two cases at the distal femur and six cases at the proximal tibia. Five cases of osteosarcoma and three cases of Ewing sarcoma underwent preoperative biopsy pathological examination. All children were treated with an artificial patch combined with hemiarthroplasty. The observation items were as follows: children's operation time, intraoperative blood loss, and postoperative complications such as incision infection, knee dislocation, periprosthetic fractures, and prosthetic breakage and loosening. Regular postoperative observation follow-up was conducted to evaluate the stability of the knee joint by drawer test abd lateral stress test; full-length X-rays of both lower limbs were performed to measure changes in the length of the lower limbs; CT and MRI examinations of the knee joint were performed to observe prosthetic looseness and local recurrence; lung CT and PET-CT examinations were also conducted. Lung metastasis and distant metastasis of the patient's tumor were observed. Three months after surgery, the American Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate the function of the affected limb at follow-up, and the range of motion (ROM) of the affected knee joint was measured to evaluate the recovery of knee joint activity. Results The operation was successfully performed for all eight childen; the operation time was 150-440 (265.2±54.2) min, and the intraoperative blood loss was 150-400 (307.5±98.7) mL. After surgery, one patient had delayed incision healing, and seven patients had primary incision healing. All eight children were followed up for 7-36 (13.8±9.9) months. During the follow-up period, the patient's gait was good, with no evident lameness and complications such as knee dislocation, periprosthetic fractures, prosthetic breakage, or loosening. At the last follow-up, the stability of the knee joint was satisfactory. The length of the lower limbs was measured on full-length X-ray films of both lower limbs. The length of the lower limbs was unequal, with a difference of 0.2-2.0 (0.9±0.6) cm. CT and MRI examinations of the knee joint were performed, and no tumors were found. No local recurrence, infection, periprosthetic fracture, knee dislocation, or prosthesis breakage or loosening was observed. Lung CT and PET/CT examinations showed no tumor metastasis. At the last follow-up, the MSTS score was 24-29 (27.5±1.5) points, and the functions of the affected limbs were excellent. In addition, the ROM was 60°-110° (95°±14.1°), and the knee joint mobility was satisfied. Conclusion An artificial patch combined with hemiarthroplasty in the treatment of primary malignant bone tumors involving the epiphysis around the knee joint in children can preserve the normal contralateral epiphysis, achieve satisfactory knee joint stability and function after surgery, and achieve good short-term clinical results.
亚地坎·亚生江, 向海滨, 田征, 陈江涛, 杨欣, 陈杨, 艾克拜尔·尤努斯, 徐磊磊, 姜大为. 人工补片联合半关节置换术治疗儿童膝关节周围累及骨骺的骨原发性恶性肿瘤的近期临床疗效[J]. 中华解剖与临床杂志, 2024, 29(3): 172-178.
Yadikan Yashengjiang, Xiang Haibin, Tian Zheng, Chen Jiangtao, Yang Xin, Chen Yang, Aikebaier Younusi, Xu Leilei, Jiang Dawei. Short-term clinical efficacy of artificial mesh combined with hemiarthroplasty in the treatment of malignant primary bone tumors involving the epiphysis around the knee joint of children. Chinese Journal of Anatomy and Clinics, 2024, 29(3): 172-178.
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