ANALYSIS OF PROSTHESIS-RELATED COMPLICATIONS AFTER EXTENSIBLE SEMI-JOINT PROSTHESIS REPLACEMENT FOR LOWER LIMBS OSTEOSARCOMA IN CHILDREN_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANMing ,  WANGBaocang , LIYong , WANGHui , LUQiang , ZHOUYueshuang

Department of Osteopathy, the Second Hospital of Tangshan(North China University of Science and Technology Affiliated Orthopedic Hospital), Tangshan Hebei, 063000, P. R. China;

Corresponding author：

WANGBaocang, Email: tshwangbaocang@163.com

Keywords：

Osteosarcoma; Extensible semi-joint prosthesis; Complication; Limb salvage surgery; Children

DOI：

10.7507/1002-1892.20150260

Video：

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Objective To investigate the causes of the complications and prevention strategy by analyzing occurrence of prosthesis-related complications after extensible semi-joint prosthesis replacement for lower limbs osteosarcoma in children. Methods Eleven children with lower limbs osteosarcoma underwent resection of tumor and replacement of the extensible semi-joint prosthesis between May 2006 and October 2012. There were 6 boys and 5 girls, with an average age of 9.3 years (range, 7-12 years). The lesions located at the distal femur in 6 cases, at the proximal femur in 2 cases, and at the proximal tibia in 3 cases. The disease duration was 2-8 months (mean, 3.6 months). According to the Enneking stage, 3 cases were rated as stage ⅡA and 8 cases as stage ⅡB. The pulmonary CT and ECT results showed no pulmonary metastasis or multi spots before operation. All patients received preoperative chemotherapy treatment for 4 times. Results Primary healing of incision was obtained in 10 cases. Infection occurred in 1 case at 1 week after operation, and was cured after symptomatic treatment. Nine patients received postoperative chemotherapy for 12 times, 2 patients for 2 times and 4 times respectively. One case died of multiple metastasis; in 3 cases of pulmonary metastasis, 2 cases died and 1 case survived after resection of metastatic lesion. Eight survival cases received a follow-up of 25-89 months (mean, 42.5 months). Loosening and dislocation of the proximal femoral prosthesis occurred in 1 case, loosening and subsidence of the distal femoral prosthesis in 1 case, subluxation in 1 case, and retraction in 1 case. The incidence of prosthesis-related complications was 50%. Lengthening operation was performed on 3 cases for 1 time, and on 1 case for 2 times. And 4 cases did not undergo lengthening operation. According to Enneking function evaluation standard after malignant tumor limb-salvage surgery, the results were excellent in 1 case, good in 3, fair in 3, and poor in 1 at last follow-up with an excellent and good rate of 50%. Conclusion The prosthesis-related complications include loosening and subsidence, dislocation, knee instability, and retraction after extensible semi-joint prosthesis replacement for lower limbs osteosarcoma. The prosthesis-related complications can be reduced by the improvement of prosthesis design and manufacture, and the use of intraoperative bone cement, artificial mesh, and postoperative restrictive brace.

Citation： YANMing, WANGBaocang, LIYong, WANGHui, LUQiang, ZHOUYueshuang. ANALYSIS OF PROSTHESIS-RELATED COMPLICATIONS AFTER EXTENSIBLE SEMI-JOINT PROSTHESIS REPLACEMENT FOR LOWER LIMBS OSTEOSARCOMA IN CHILDREN. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1194-1198. doi: 10.7507/1002-1892.20150260 Copy

1.	Marina N, Gebhardt M, Teot L, et al. Biology and therapeutic advances for pediatric osteosarcoma. Oncologist, 2004, 9(4):422-441.
2.	杨荣利, 徐万鹏, 郭卫, 等. 特制半关节假体置换在儿童膝关节恶性骨肿瘤中的应用. 中国骨肿瘤骨病, 2005, 4(1):1-4.
3.	沈靖南, 尹军强. 儿童恶性骨肿瘤保肢术及其尚待解决的问题. 中华关节外科杂志(电子版), 2012, 6(3):449-451.
4.	胡猛, 李彦林, 仝路. 股骨远端旋转力线定位标志研究进展. 中国修复重建外科杂志, 2013, 27(1):54-57.
5.	张金利, 宋金纲, 程明, 等. 人工补片在恶性肿瘤人工关节置换修补中的临床应用. 中国肿瘤临床, 2006, 33(13):750-753.
6.	陈勇, 宋金纲, 杨蕴, 等. 恶性肿瘤关节置换中人工补片的作用. 中国骨肿瘤骨病, 2010, 9(1):24-28.
7.	Browne JA, Hanssen AD. Reconstruction of patellar tendon disruption after total knee arthroplasty:results of a new technique utilizing synthetic mesh. J Bone Joint Surg (Am), 2011, 93(12):1137-1143.
8.	徐海荣, 牛晓辉, 张清, 等. 人工补片用于胫骨假体近端重建髌韧带附丽的生物力学特点和组织学表现. 中国骨与关节杂志, 2012, 1(6):627-630.
9.	马明, 王艳. 周围神经的生物力学研究进展. 中国康复医学杂志, 2014, 29(3):295-298.
10.	Farrell CM, Springer BD, Haidukewych GJ, et al. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg (Am), 2005, 87(12):2619-2625.
11.	张力, 王伟, 秦泗河. 肢体延长结果对再生医学的启迪. 中国矫形外科杂志, 2014, 22(5):445-448.
12.	Simpson AH, Gillingwater TH, Anderson H, et al. Effect of limb lengthening on intermodal length and conduction velocity of peripheral nerve. J Neurosci, 2013, 33(10):4536-4539.
13.	Eralp L, Kocaoğlu M, Polat G, et al. A comparison of external fixation alone or combined with intramedullary nailing in the treatment of segmental tibial defects. Acta Orthop Belg, 2012, 78(5): 652-659.
14.	陈艺, 叶劲, 白波, 等. 复杂髋关节手术中应用电生理监测技术预防下肢周围神经损伤. 中华关节外科杂志(电子版), 2013, 7(5):25-28.

1. Marina N, Gebhardt M, Teot L, et al. Biology and therapeutic advances for pediatric osteosarcoma. Oncologist, 2004, 9(4):422-441.
2. 杨荣利, 徐万鹏, 郭卫, 等. 特制半关节假体置换在儿童膝关节恶性骨肿瘤中的应用. 中国骨肿瘤骨病, 2005, 4(1):1-4.
3. 沈靖南, 尹军强. 儿童恶性骨肿瘤保肢术及其尚待解决的问题. 中华关节外科杂志(电子版), 2012, 6(3):449-451.
4. 胡猛, 李彦林, 仝路. 股骨远端旋转力线定位标志研究进展. 中国修复重建外科杂志, 2013, 27(1):54-57.
5. 张金利, 宋金纲, 程明, 等. 人工补片在恶性肿瘤人工关节置换修补中的临床应用. 中国肿瘤临床, 2006, 33(13):750-753.
6. 陈勇, 宋金纲, 杨蕴, 等. 恶性肿瘤关节置换中人工补片的作用. 中国骨肿瘤骨病, 2010, 9(1):24-28.
7. Browne JA, Hanssen AD. Reconstruction of patellar tendon disruption after total knee arthroplasty:results of a new technique utilizing synthetic mesh. J Bone Joint Surg (Am), 2011, 93(12):1137-1143.
8. 徐海荣, 牛晓辉, 张清, 等. 人工补片用于胫骨假体近端重建髌韧带附丽的生物力学特点和组织学表现. 中国骨与关节杂志, 2012, 1(6):627-630.
9. 马明, 王艳. 周围神经的生物力学研究进展. 中国康复医学杂志, 2014, 29(3):295-298.
10. Farrell CM, Springer BD, Haidukewych GJ, et al. Motor nerve palsy following primary total hip arthroplasty. J Bone Joint Surg (Am), 2005, 87(12):2619-2625.
11. 张力, 王伟, 秦泗河. 肢体延长结果对再生医学的启迪. 中国矫形外科杂志, 2014, 22(5):445-448.
12. Simpson AH, Gillingwater TH, Anderson H, et al. Effect of limb lengthening on intermodal length and conduction velocity of peripheral nerve. J Neurosci, 2013, 33(10):4536-4539.
13. Eralp L, Kocaoğlu M, Polat G, et al. A comparison of external fixation alone or combined with intramedullary nailing in the treatment of segmental tibial defects. Acta Orthop Belg, 2012, 78(5): 652-659.
14. 陈艺, 叶劲, 白波, 等. 复杂髋关节手术中应用电生理监测技术预防下肢周围神经损伤. 中华关节外科杂志(电子版), 2013, 7(5):25-28.

Chinese Journal of Reparative and Reconstructive Surgery

ANALYSIS OF PROSTHESIS-RELATED COMPLICATIONS AFTER EXTENSIBLE SEMI-JOINT PROSTHESIS REPLACEMENT FOR LOWER LIMBS OSTEOSARCOMA IN CHILDREN

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