儿童肢体骨肉瘤切除后骨缺损重建策略

Strategies for Bone Defect Reconstruction Following Resection of Extremity Osteosarcoma in Pediatric Patients

摘要: 骨肉瘤(Osteosarcoma, OS)是儿童和青少年中最常见的原发性恶性骨肿瘤，通常好发于长骨干骺端，最常见于膝关节周围。近年来，随着新辅助化疗、计算机导航技术及3D打印技术的飞速发展，保肢手术已取代截肢，成为临床标准治疗方案。保肢手术治疗中最关键的环节即为肿瘤骨的完全切除及骨缺损的重建。在骨缺损重建中，由于儿童处于生长发育期，保肢手术面临着维持肢体生长潜能、减少双下肢不等长以及满足高活动量需求等特有挑战。在目前的医疗条件下，重建方式有多种选择，但仍存在着许多临床难题。本文回顾了近五年的文献，对儿童下肢骨肉瘤保肢手术中的主要重建方式进行综述，以期为临床个体化治疗提供参考。

Abstract: Osteosarcoma (OS) is the most common primary malignant bone tumor in children and adolescents, predominantly arising in the metaphyseal regions of long bones, most frequently around the knee joint. In recent years, driven by rapid advancements in neoadjuvant chemotherapy, computer-assisted navigation, and 3D printing technologies, limb-salvage surgery has replaced amputation to become the standard of care in clinical practice. The most critical components of limb-salvage surgery are the complete resection of the osseous tumor and the subsequent reconstruction of the bone defect. Because pediatric patients are still undergoing skeletal growth and development, reconstructing these bone defects presents unique challenges, including the preservation of limb growth potential, the minimization of limb-length discrepancy (LLD), and the accommodation of high functional activity levels. Although various reconstruction modalities are available under current medical conditions, numerous clinical dilemmas persist. This article reviews the literature over the past five years to comprehensively summarize the principal reconstruction strategies employed in limb-salvage surgery for pediatric lower extremity osteosarcoma, aiming to provide a valuable reference for individualized clinical decision-making.