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Transepiphyseal resection for osteosarcoma in patients with open physes using MRI assessment.

使用MRI评估经骨骺切除治疗开放骨骺患者骨肉瘤。

  • 影响因子:3.58
  • DOI:10.1302/0301-620X.102B6.BJJ-2019-1141.R2
  • 作者列表:"Kim Y","Jang WY","Park JW","Park YK","Cho HS","Han I","Kim HS
  • 发表时间:2020-06-01
Abstract

AIMS:For paediatric and adolescent patients with growth potential, preservation of the physiological joint by transepiphyseal resection (TER) of the femur confers definite advantages over arthroplasty procedures. We hypothesized that the extent of the tumour and changes in its extent after neoadjuvant chemotherapy are essential factors in the selection of this procedure, and can be assessed with MRI. The oncological and functional outcomes of the procedure were reviewed to confirm its safety and efficacy. METHODS:We retrospectively reviewed 16 patients (seven male and nine female, mean age 12.2 years (7 to 16)) with osteosarcoma of the knee who had been treated by TER. We evaluated the MRI scans before and after neoadjuvant chemotherapy for all patients to assess the extent of the disease and the response to treatment. RESULTS:The mean follow-up period was 64.3 months (25 to 148) after surgery and no patients were lost to follow-up. On MRI evaluation, 13 tumours were near but not in contact with the physes and three tumours were partially in contact with the physes before neoadjuvant chemotherapy. Bone oedema in the epiphysis was observed in eight patients. After neoadjuvant chemotherapy, bone oedema in the epiphysis disappeared in all patients. In total, 11 tumours were not in contact and five tumours were in partial contact with the physes. The postoperative pathological margin was negative in all patients. At the last follow-up, 12 patients were continuously disease-free and three had no evidence of disease. One patient died due to the disease. Functionally, the patients with retained allograft or recycled autograft had a mean knee range of flexion of 126° (90° to 150°). The mean Musculoskeletal Tumor Society functional score was 27.6 (23 to 30). CONCLUSION:TER is an effective limb-salvage technique for treating malignant metaphyseal bone tumours in paediatric and young osteosarcoma patients with open physes when a good response to chemotherapy and no progression of the tumour to the epiphysis have been confirmed by MRI. Cite this article: Bone Joint J 2020;102-B(6):772-778.

摘要

目的: 对于有生长潜力的儿童和青少年患者,通过股骨穿骨骺切除术 (TER) 保留生理关节比关节成形术具有明确的优势。我们假设新辅助化疗后肿瘤的范围及其范围的变化是选择该术式的必要因素,可以用MRI进行评估。回顾了该手术的肿瘤学和功能结局,以确认其安全性和有效性。 方法: 我们回顾性分析了 16 例接受TER治疗的膝关节骨肉瘤患者 (7 例男性和 9 例女性,平均年龄 12.2 岁 (7 ~ 16 岁))。我们评估了所有患者新辅助化疗前后的MRI扫描,以评估疾病的程度和对治疗的反应。 结果: 术后平均随访 64.3 个月 (25 ~ 148),无患者失访。在MRI评价中,13 个肿瘤靠近但不与骨骺接触,3 个肿瘤在新辅助化疗前部分与骨骺接触。在 8 例患者中观察到骨骺的骨水肿。新辅助化疗后,所有患者骨骺处的骨水肿消失。总共有 11 例肿瘤不接触,5 例肿瘤部分接触骨骺。所有患者术后病理切缘均为阴性。在最后一次随访时,12 例患者持续无病,3 例无疾病证据。1 例患者因该病死亡。功能上,保留同种异体移植物或回收自体移植物的患者平均膝关节屈曲范围为 126 ° (90 ° 至 150 °)。平均肌肉骨骼肿瘤协会功能评分为 27.6 (23 ~ 30)。 结论: TER是一种有效的保肢技术,用于治疗儿童和年轻的开放性骨肉瘤患者的恶性干骺端骨肿瘤,当化疗反应良好且肿瘤未进展至骨骺时。经MRI证实。引用本文: 骨关节J 2020;102-B(6):772-778。

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DOI:10.1177/1078155219842277
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骨肿瘤方向

骨肿瘤是发生于骨骼或其附属组织的肿瘤。有良性,恶性之分,良性骨肿瘤易根治,预后良好,恶性骨肿瘤发展迅速,预后不佳,死亡率高。

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