OBJECTIVE: To explore the effectiveness of artificial hemi-knee prosthesis reconstruction for bone defects after resection of pediatric osteosarcoma. METHODS: A retrospective analysis was conducted on the clinical data of 18 children with osteosarcoma who met the selection criteria and were treated between January 2016 and December 2019. There were 11 males and 7 females, aged 6-10 years (mean, 8.9 years). Osteosarcoma located in the distal femur in 11 cases and the proximal tibia in 7 cases. Among them, 12 cases were conventional osteosarcoma and 6 cases were small cell osteosarcoma, with a disease duration of 1-9 months (mean, 3.1 months). All patients received 2 cycles of preoperative chemotherapy with doxorubicin, cisplatin, and ifosfamide. After en bloc tumor segment resection, bone defects were reconstructed using custom-made artificial hemi-knee prostheses. Rehabilitation training was initiated at 8 weeks postoperatively under the protection of a knee immobilizer brace, combined with 4 cycles of adjuvant chemotherapy. During follow-up, lower limb growth length and limb shortening (compared with the healthy side) were measured, and limb function was evaluated using the Musculoskeletal Tumor Society-93 (MSTS-93) scoring system. RESULTS: All surgeries were successfully completed, with an operation time of 2.0-3.1 hours (mean, 2.4 hours) and intraoperative blood loss of 180-320 mL (mean, 230.0 mL). Incisional edge necrosis occurred in 1 case at 10 days postoperatively, while the incisions of the remaining 17 patients healed by first intention. One case developed periprosthetic infection caused by Staphylococcus aureus at 1 week postoperatively, which was cured after symptomatic treatment. All 18 patients were followed up 60-96 months (mean, 74.2 months). No local tumor recurrence was observed during follow-up. Imaging examinations showed prosthesis loosening in 2 cases, while the prosthesis of other patients were well-positioned. At last follow-up, the knee joint range of motion was 80°-120° (mean, 106.7°). The MSTS-93 score was 16-29 (mean, 24.7), with 12 cases rated as excellent, 5 good, and 1 fair. The patients' height increased by 12.8-20.0 cm (mean, 15.5 cm), the lower limb growth length was 6.0-13.0 cm (mean, 9.7 cm), and limb shortening was 1.8-4.6 cm (mean, 3.1 cm). There was no significant difference in MSTS-93 scores, lower limb growth length, or limb shortening between the distal femur group and the proximal tibia group ( P>0.05). CONCLUSION Artificial hemi-knee prosthesis reconstruction can preserve the adjacent normal epiphysis of the knee joint, maximize limb growth potential, and reduce adult limb length discrepancy, making it a suitable reconstruction option for children with knee osteosarcoma.
Humans ; Osteosarcoma/surgery* ; Male ; Child ; Female ; Knee Prosthesis ; Retrospective Studies ; Bone Neoplasms/surgery* ; Plastic Surgery Procedures/methods* ; Tibia/surgery* ; Femur/surgery* ; Arthroplasty, Replacement, Knee/methods* ; Treatment Outcome ; Chemotherapy, Adjuvant ; Femoral Neoplasms/surgery*

Objective To translate the International Consultation on Incontinence Modular Questionnaire for Male Lower Urinary Tract Symptoms (ICIQ-MLUTS) and ICIQ-MLUTS long form (ICIQ-MLUTS LF) into Chinese and assess their metric properties and applicability.Methods After obtaining permission from the International Consultation on Incontinence Questionnaire (ICIQ),original ICIQ-MLUTS and ICIQ-MLUTS LF were translated into Chinese according to ICIQ validation protocol and cultural adaptation guideline.During November 2017 to August 2018,Chinese version of ICIQ-MLUTS and ICIQ-MLUTS LF were tested by administering them in 6 and 12 hospitals in China respectively.To validate the translated questionnaires,the following tests were undertaken.The content validity was determined by indepth interviews with participants and experts.The correlation coefficients of ICIQ-MLUTS and ICIQ-MLUTS LF with International Prostate Symptom Score (IPSS) were assessed to validate criterion validity.Cronbach's alpha test was used to explore internal consistency.And the test-retest reliability was evaluated by calculation of intraclass correlation coefficient.Results In total,Chinese ICIQ-MLUTS and ICIQ-MLUTS LF were administrated to 135 and 230 male patients with lower urinary tract symptoms respectively.Both questionnaires had good content validity and good criterion validity with IPSS (Pearson correlation 0.846 and 0.833 for ICIQ-MLUTS and ICIQ-MLUTS LF respectively,both P ＜ 0.001).The Cronbach's alpha coefficient was 0.797 for ICIQ-MLUTS,and 0.853 for ICIQ-MLUTS LF.Intraclass correlation coefficient was 0.986 and 0.985 respectively (both P ＜ 0.001),showing good test-retest reliability.Conclusions The Chinese version of ICIQ-MLUTS and ICIQ-MLUTS LF had good validity and reliability,which can be used to assess Chinese male patients with lower urinary tract symptoms.