Reconstruction with preservation of the epiphysis by using custom-made prosthesis in children with distal femoral osteosarcomas / 中华骨科杂志

ABSTRACT

Objectives To evaluate the preliminary effectiveness,investigate the clinical methods and prevent the complications of the epiphysis preservation operation by using custom-made prosthesis in children with distal femoral osteosarcomas.Methods Between August 2012 and July 2013,3 patients (from 8 to 14 years old) who were diagnosed of osteosarcoma underwent tumor segmental resection and epiphysis preservation operation and reconstruction with custom-made prosthesis.Patients were assigned neoadjuvant chemotherapy 1 to 2 cycles.The effect of neoadjuvant chemotherapy was then evaluated by X-ray,CT and MRI.Patients were determined the disease field by MRI,customized prosthesis by computer and had surgery of tumor segmental resection and reconstruction with custom-made prosthesis.All individuals were given appropriate functional exercise after operation,standard chemotherapy after incision healing one week,and long-time follow-ups.Results The operation times were 3 hours,4 hours and 6 hours.The bleeding losses during operation were 300 ml,500 ml and 2200 ml,respectively.The functional scores according to the scoring system of the Musculoskeletal Tumor Society (MSTS) after 12-24 months follow-ups were 24,26 and 13,respectively.And excellent functional results were obtained in short-time follow-ups.1 patient had prosthesis infection and amputation was taken after failing in conservative treatment.Unequal lengths of both lower extremities in 2 patients were less than 2 cm.Conclusion For the pediatric distal femoral osteosarcomas that has surgical indications,a new theory and therapy idea on combination of epiphysis preservation operation with custom-made prosthesis and neoadjuvant chemotherapy and standardized postoperative chemotherapy is suggested.And it has advantages of effective curative effect,easy operation,short operative time and quick recovery.However,long-term outcomes of complications should be observed further.