Background:The optimal treatment for proximal tibial osteosarcoma (OS) in skeletally immature patients remains controversial. A custom hinged endoprosthesis has been used to preserve the growth potential of the distal femur. This study aims to report (1) the 2-year follow-up outcomes after surgery for pediatric proximal tibial OS; (2) the complications associated with this endoprosthesis; and (3) the extent to which the growth potential of the adjacent open physis can be preserved.Methods:Seven skeletally immature patients (mean age, 11.1 years; range, 9–13 years) with proximal tibial OS were included between November 2020 and December 2022. All underwent tumor resection and reconstruction by this custom endoprosthesis. Postoperative limb function was evaluated by the Musculoskeletal Tumor Society (MSTS) score system and complications were recorded. Overall leg length and femoral length were measured radiographically to determine the growth rate.Results:The mean follow-up time was 34.7 months (standard deviation (SD), 8.9 months). One patient presented with local recurrence 12 months after surgery, and another patient had pulmonary metastasis 3 months postoperatively. The range of flexion of the knee after rehabilitation was between 90° and 125°, with an average of 103.6° (SD, 12.5°). The average MSTS score of the patients after surgery was 27.4 (SD, 1.5). Wound dehiscence took place in three patients after chemotherapy. At the last follow-up, the overall limb length discrepancy was 2.1 cm (SD, 2.4 cm). Growth at the distal femoral physis after surgery was observed in all patients during follow-up, with an average of 81.4% (range, 57.78–100%) of growth of the contralateral distal femoral physis.Conclusions:This custom hinged endoprosthesis can preserve the growth potential of the adjacent distal femur and provide satisfying functional outcomes with lower postoperative complication rate. It could serve as an alternative for proximal tibial OS in skeletally immature children.
背景：对于骨骼未成熟患者的胫骨近端骨肉瘤，其最佳治疗方案仍存在争议。定制铰链式内假体已被用于保留股骨远端的生长潜力。本研究旨在报告：（1）儿童胫骨近端骨肉瘤术后的2年随访结果；（2）与该内假体相关的并发症；（3）邻近开放骨骺生长潜力得以保留的程度。方法：研究纳入了2020年11月至2022年12月期间收治的7例骨骼未成熟的胫骨近端骨肉瘤患者（平均年龄11.1岁，范围9-13岁）。所有患者均接受了肿瘤切除及该定制内假体重建术。术后肢体功能采用肌肉骨骼肿瘤协会评分系统进行评估，并记录并发症。通过影像学测量整体腿长和股骨长度以确定生长率。结果：平均随访时间为34.7个月（标准差8.9个月）。1例患者于术后12个月出现局部复发，另1例患者于术后3个月发生肺转移。康复后膝关节屈曲范围在90°至125°之间，平均为103.6°（标准差12.5°）。患者术后平均MSTS评分为27.4分（标准差1.5分）。3例患者在化疗后出现伤口裂开。末次随访时，整体肢体长度差异平均为2.1厘米（标准差2.4厘米）。所有患者在随访期间均观察到术后股骨远端骨骺的生长，其生长量平均达到对侧股骨远端骨骺生长量的81.4%（范围57.78%-100%）。结论：该定制铰链式内假体能够保留邻近股骨远端的生长潜力，提供令人满意的功能结果，且术后并发症发生率较低。它可作为骨骼未成熟儿童胫骨近端骨肉瘤的一种替代治疗方案。
肿瘤(癌症)患者之家