Вопросы гематологии/онкологии и иммунопатологии в педиатрии. 2019; 18: 55-61
Эндопротезирование коленного сустава как хирургический этап лечения пациентов детского и подросткового возраста с опухолями костей
https://doi.org/10.24287/1726-1708-2019-18-1-55-61Аннотация
В статье представлен анализ собственного опыта удаления опухолей и последующего эндопротезирования у пациентов детского и подросткового возраста с первичными опухолями костей. Данное исследование поддержано Независимым этическим комитетом и утверждено решением Ученого совета НМИЦ ДГОИ. За 5-летний период (2012-2017) выполнены 65 эндопротезирований коленного сустава у детей и подростков с онкологической патологией. Оценку функциональных результатов проводили с помощью шкалы MSTS через 3 месяца с момента операции. Послеоперационные осложнения анализировали согласно классификации по Henderson. Средний показатель функционального результата после оперативного лечения по шкале MSTS составил 76%. Чаще среди послеоперационных осложнений отмечены структурные повреждения (7,6%) и инфекционные осложнения (6,2%). Общая выживаемость в наиболее многочисленной группе пациентов с остеосаркомой (56 человек) составила 82 ± 12%; бессобытийная выживаемость - 37 ± 12%. Использование индивидуальных раздвижных эндопротезов позволяет проводить операции пациентам детского возраста - с незрелым скелетом. Эндопротезирование обеспечивает хорошие онкологические и функциональные результаты, способствует наибольшей социальной адаптации ребенка.
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24. Staals E.L., Colangeli M., Ali N., Casanova J.M., Donati D.M., Manfrini M. Are Complications Associated With the Repiphysis Expandable Distal Femoral Prosthesis Acceptable for Its Continued Use? Clin Orthop Relat Res 2015; 473: 3003-13.
25. Harris W.H., Sledge C.B. Total hip and total knee replacement. N Eng J Med 1990; 323: 801-7.
26. Fabbri N., Donati D. Periprosthetic fractures around megaprostheses of the knee after limb salvage surgery for bone tumor. EMSOS Italy 2005; Abstract book: 45-6.
27. Hardes J., Gebert C., Schwappch A., Ahrens H., Streitburger A., Winkelmann W., et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg 2006; 126: 289-96.
28. Morii T., Yabe H., Morioka H., Beppu Y., Chuman H., Kawai A. Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci 2010; 15: 331-9.
29. Sharil A.R., Nawaz A., Noz Azman M., Zulmi W., Faisham W. Early Functional Outcome of Resection and Endoprosthesis Replacement for Primary Tumor around the Knee. Malays Orthop J 2013; 7 (1): 30-5.
30. Ness K.K., Neel M.D., Kaste S.C., Billups C.A., Marchese V.G., Rao B.N. A comparison of Function after Limb Salvage with Noninvasive Expandable or Modular Prostheses in Children. Eur J Cancer 2014; 50 (18): 3212-20.
Pediatric Hematology/Oncology and Immunopathology. 2019; 18: 55-61
Endoprosthesis reconstruction, as a surgical treatment of children and adolescence with bone tumors around the knee
https://doi.org/10.24287/1726-1708-2019-18-1-55-61Abstract
Aim: analysis of own experience in endoprosthesis reconstruction of the knee for children and adolescents with primary bone tumors. The article reports the results of 65 endoprosthesis reconstruction of the knee joint in children and adolescents with oncological pathology for a 5-year period (2012-2017). The study was approved by the Independent Ethics Committee of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology, and Immunology. Evaluation of functional results was performed using the MSTS scale 3 months after the operation. Postoperative complications were analyzed according to the Henderson classification. The average indicator of the functional rate after operative treatment, according to the MSTS scale, was 76%. The most common postoperative complications were structural failures (7.6%) and infectious complications (6.2%). Overall survival in the largest group of patients with osteosarcoma (56 patients) was 82 ± 12%, event-free survival 37 ± 12%. The use of individual expandable endoprostheses makes it possible to perform operations for patients with skeletal immaturity. Endoprosthesis replacement provide good oncological and functional results, and also contribute to the most adequate social adaptation of the child.
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7. Picci P., Manfrini M., Fabbri N., Gambaro-tti M., Vanel D. Atlas of Muscoloskeletal Tumors and Tumorlike Leesions. Springer International Publishing Switzerland 2014; 147: 203.
8. Kaatsch P., Strothotte J., Becker C., Bielack S., Dirksen U., Blettner M. Pediatric bone tumors in Germany from 1987 to 2011: incidence rates, time trends and survival. Acta Oncologica 2016; 55 (9-10): 1145-51.
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10. Wu X., Cai Z.D., Chen Z., Yao Z.J., Zhang G.J. A preliminary evaluation of limb salvage surgery for osteosarcoma around knee joint. PlosOne 2012; 7 (3): 1-6.
11. Neel M.D., Wilkins R.M., Rao B.N., Kelly C.M. Early Multicenter Experience with a Noninvasive Expandable Prosthesis. Clinical Orthopaedics and Related Research 2003; 415: 72.
12. Aiona M., Do K.P., Emara K., Doro-ciak R., Pierce R. Gait Patterns in Children With Limb Length Discrepancy. J Pediatr Orthop 2015; 35 (3): 280-4.
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16. Andreou D., Bielack S.S., Carrle D., Kevric M., Kotz R., Winkelmann W. The Influence of tumor- and treatment-related factors on the development of local recurrencein osteosarcoma after adequate surgery. An analysis of 1355 patients treated on neoadjuvant Cooperative Osteosarcoma Study Group protocols. Ann Oncol 2011; 22: 1228-35.
17. Cloake Th.P., Jeys L.M. How Important are surgical margins in Osteosarcoma? J Bone & Soft Tissue Tumors 2016; 2 (1): 22-6.
18. Beebe K., Benevenia J., Kaushal N., Uglialoro A., Patel N., Patterson F. Evaluation of a Noninvasive Expandable Prosthesis in Musculoskeletal Oncology Patients for the Upper and Lower Limb. Orthopedics 2010; 33 (6): 396.
19. Eckard J.J., Eilber F.R., Dorey F.J., Mirra J.M. The UCLA experience in limb salvage surgery of malignant tumors. Orthopedics 1985; 8 (5): 612-21.
20. Capanna R., Scoccianti G., Campanac-ci D.A., Beltrami G., De Biase P. Extraarticular Knee Resection with Prosthesis-Proximal Tibia-extensor Apparatus Allograft for Tumors Invading the Knee. Clin Orthop Relat Res 2011; 469: 2905-14.
21. Zwolak P., Kuhnel S.P., Fuchs B. Extraarticular Knee Resection for Sarcomas with Preservation of the Extensor Mechanism. Clin Orthop Relat Res 2011; 469: 251-6.
22. Blunn G.W., Briggs T.W.R., Cannon S.R., Walker P.S., Unwin P.S., Culligan S.M. Cementless Fixation for Primary Segmental Bone Tumor Endoprostheses. Clinical Orthopaedics and Related Research 2000; 372: 223-30.
23. Coathup M.J., Baata V., Pollock R.C., Aston W.J., Cannon S.R., Skinner J.A., et al. Lonr-Term Survival of Cemented Distal Femoral Endoprostheses with a Hydroxyapatite-Coated Collar. J Bone & Joint Surgery 2013; 95 (17): 1569-75.
24. Staals E.L., Colangeli M., Ali N., Casanova J.M., Donati D.M., Manfrini M. Are Complications Associated With the Repiphysis Expandable Distal Femoral Prosthesis Acceptable for Its Continued Use? Clin Orthop Relat Res 2015; 473: 3003-13.
25. Harris W.H., Sledge C.B. Total hip and total knee replacement. N Eng J Med 1990; 323: 801-7.
26. Fabbri N., Donati D. Periprosthetic fractures around megaprostheses of the knee after limb salvage surgery for bone tumor. EMSOS Italy 2005; Abstract book: 45-6.
27. Hardes J., Gebert C., Schwappch A., Ahrens H., Streitburger A., Winkelmann W., et al. Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg 2006; 126: 289-96.
28. Morii T., Yabe H., Morioka H., Beppu Y., Chuman H., Kawai A. Postoperative deep infection in tumor endoprosthesis reconstruction around the knee. J Orthop Sci 2010; 15: 331-9.
29. Sharil A.R., Nawaz A., Noz Azman M., Zulmi W., Faisham W. Early Functional Outcome of Resection and Endoprosthesis Replacement for Primary Tumor around the Knee. Malays Orthop J 2013; 7 (1): 30-5.
30. Ness K.K., Neel M.D., Kaste S.C., Billups C.A., Marchese V.G., Rao B.N. A comparison of Function after Limb Salvage with Noninvasive Expandable or Modular Prostheses in Children. Eur J Cancer 2014; 50 (18): 3212-20.
