Levent ERALP, Berkin TOKER, TURGUT AKGÜL, Harzem ÖZGER, Mehmet KOCAOĞLU, Sikander HAYAT

Kas-iskelet sistemi tümörlerinin ve cerrahi tedavi komplikasyonlarının tedavisinde eksternal ﬁksatör uygulamaları

Amaç: Kemik tümörüne bağlı veya tümör cerrahisi sonrası gelişen komplikasyonların tedavisinde eksternal ﬁksatör (EF) yönteminin sonuçları ve tedavi süreci değerlendirildi. Çalışma planı: Çalışmada EF ile tedavi edilen 18 hasta (9 erkek, 9 kadın; ort. yaş 19; dağılım 6-35) üç grupta incelendi. Histolojik tanılar osteosarkom (n=3), Ewing sarkomu (n=3), kalıtımsal multipl egzostoz (n=3), kondrosarkom (n=2), sinovyal sarkom (n=2) ve birer olguda Ollier hastalığı, dev hücreli kemik tümörü, desmoid ﬁbrom, kondromiksoid ﬁbrom ve enkondrom idi. Kemik tümörüne bağlı (n=4) veya ekstremite koruyucu cerrahi sonrasında (n=14) gelişen komplikasyonların tedavisinde dokuz hastada Ilizarov tipi sirküler EF, altı hastada tek taraﬂı EF, üç hastada isi her iki tip EF kullanıldı. Sonuçlar: Birinci grupta, tümör cerrahisi sonrası gelişen deformite veya enfekte kaynamama nedeniyle EF ile tedavi edilen sekiz hasta vardı. Bu hastalarda ortalama kısalık 10.6 cm, ortalama uzatma 9.7 cm, tedavi ﬁksatör indeksi 48.8 gün/ cm idi. Bir hastada ﬁksatörün çıkarılmasından sonra damar- lı ﬁbula greftinde kırık gelişti, iki hastada ise amputasyon gerekti. İkinci grupta, tümör cerrahisi sonrası ortaya çıkan kısalığın tedavi edildiği altı hasta vardı. Ortalama kısalık 7.5 cm, ortalama uzatma 6.5 cm, tedavi ﬁksatör indeksi 28 gün/ cm idi. Bu grupta önemli komplikasyonlar implant sorunları ve diz hareket kısıtlılığı idi. Üçüncü grupta, tümörün kendisinden (3 multipl egzostoz, 1 Ollier hastalığı) kaynaklanan deformite ve kısalığı olan dört hasta vardı. Bu grupta ortalama kısalık 7.5 cm, ortalama uzatma 6.5 cm, tedavi ﬁksatör indeksi 57.2 gün/cm idi. Bir hastada büyüme atağı sonrası 2 cm ulnar kısalık gelişti. Çıkarımlar: Özellikle genç hastalarda kemik tümörüne veya kemik tümörü cerrahisine bağlı komplikasyonların tedavisinde EF tedavisi ile başarılı sonuçlar elde edilmiştir.

Anahtar Kelimeler:

Osteosarkom, Osteogenez, distraksiyon, Eksternal fiksatörler, Kemik neoplazmları, Kırık tespiti, Kas neoplazmları, Ameliyat sonrası komplikasyonlar

Applications of external ﬁxation for management of complications associated with musculoskeletal tumors and related surgery

Objectives: We evaluated the results of, and the course of treatment with, external ﬁxation (EF) in treating complications associated with bone tumors and related surgery. Methods: Eighteen patients (9 males, 9 females; mean age 19 years; range 6 to 35 years) who were treated with EF were evaluated in three groups. Histologic diagnoses were osteosarcoma (n=3), Ewing’s sarcoma (n=3), hereditary multiple exostosis (n=3), chondrosarcoma (n=2), synovial sarcoma (n=2), Ollier’s disease, giant cell tumor of bone, desmoid ﬁbroma, chondromyxoid ﬁbroma, and enchondroma. Complications secondary to bone tumors (n=4) and occurring following limb salvage surgery (n=14) were treated with Ilizarov circular EF in nine pa- tients, unilateral EF in six patients, and both in three patients. Results: The ﬁrst group included eight patients who were treated with EF for infection and nonunion or deformity following surgery. The mean shortening was 10.6 cm, the mean lengthen- ing was 9.7 cm, and the mean external ﬁxator index was 48.8 days/cm. One patient developed fracture of the free vascularized ﬁbula graft after EF removal, and amputation was required in two patients. The second group consisted of six patients who had shortening secondary to tumor surgery. The mean shortening was 7.5 cm, the mean lengthening was 6.5 cm, and the mean external ﬁxator index was 28 days/cm. In this group, the major complications were implant failure and knee stiffness. The third group included four patients with deformity and shortening secondary to multiple exostosis (n=3) and Ollier’s disease. The mean shortening was 7.5 cm, the mean lengthening was 6.5 cm, and the mean external ﬁxator index was 57.2 days/cm. One patient developed ulnar shortening of 2 cm after growth. Conclusion: The use of EF in the management of complications associated with bone tumors and related surgery yields successful results especially in young patients.

Keywords:

Osteosarcoma, Osteogenesis, Distraction, External Fixators, Bone Neoplasms, Fracture Fixation, Muscle Neoplasms, Postoperative Complications,

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