摘要目的 探讨带蒂腓骨膜转位移植覆盖灭活骨-自体骨断端以促进儿童胫骨肿瘤灭活再植后骨愈合的临床效果.方法 自2016年6月至2016年12月,在儿童胫骨恶性(侵袭性)骨肿瘤的瘤段骨体外射线灭活再植术中,应用同侧带蒂腓骨膜逆行转位覆盖灭活骨-自体骨断端,以促进灭活瘤段骨在体内的愈合,防止骨不连发生.共应用5例,男2例,女3例,平均12(9～15)岁.其中骨肉瘤3例,尤文肉瘤1例,反复复发的胫骨朗格汉斯组织细胞增生症1例;瘤段骨平均长度17.2(14.0～20.0)cm,2例瘤段骨包含膝关节面,3例为单纯骨干.瘤段骨灭活方法为术中体外射线照射灭活.术后定期随访,拍摄X线、CT观察患肢功能及瘤段骨愈合、并发症等情况.本组患儿术后12个月随访时进行MTSS评分.结果 所有病例均获得满意随访,平均随访14.2(12～18)个月,5例患者共8处灭活骨-自体骨断端均完全愈合,腓骨膜转位覆盖的胫骨远侧断端平均愈合时间7.8(6～10)个月,骨膜覆盖区域成骨明显.单纯骨干灭活病例因保留骺板未发生双下肢不等长,骨关节灭活的2例患儿因回植后骺板失去活力而在末次随访时患肢较对侧肢体分别短缩1.0cm和1.5cm.本组患肢MTSS评分平均25.8(22～28)分,MTSS％平均86％(73％～93％).结论 带蒂腓骨膜转位移植能够有效地促进儿童胫骨灭活瘤段骨在体内的愈合过程,具有操作简便、并发症少的特点.

abstractsObjective To investigate the clinical effect of irradiated-host bone ends' union after transplantation of pedicled vascularized fibular periosteum in the treatment of Children's tibia sarcoma.Methods From June,2016 to December,2016,there were 5 children of tibia sarcoma,which were 2 boys and 3 girls,aged of 9-15 years (mean,12 years).They were treated by the re-transplantation of extracorporal irradiated segmental autograft,and used ipsilateral pedicled vascularized fibular periosteum cover the ends of irradiated-host bone to shorten the bone union time of irradiated tibia autograft and prevent nonunion.Patients were 3 cases of osteosarcoma,1 of Ewing's sarcoma,and 1 of relapse of Langerhans's cell histocytosis in tibia.The length of resect bone was 14.0-20.0 cm (mean,17.2cm),constitute of 2 osteoarticular resections and 3 intercalary resections.The method of inactivation of bone segment was intraoperative extracorporal irradiation.Regular followed-up were done postoperative.The X-ray and CT were applied to observe the function of affect limb.The bone union time and complication were record.Results All patients were followed-up of 12-18 months (mean,14.2 months).Eight ends of irradiated-host bone in 5 patients healed completely in 7.8 (6-10) months postoperative.The region of ends were covered by periosteum and showed excellent osteogenic power.There was no leg length discrepancy occurred in patients who received intercalary inactivation because of the preservation of growth plate.But the other 2 osteoarticular inactivated patients suffered leg length discrepancy of 1.0 cm and 1.5 cm respectively because of the inactivation of growth plate.At the follow-up of 12 months post-operation,the mean MTSS of affect limb was 25.8(22-28),and the mean of MTSS％ was 86％(73％-93％).Conclusion Transplantation of pedicled vascularized fibular periosteum can promote effectively healing of irradiated tibia bone after replantation in Children,with simple operation and less complications.