腫瘍切除後血管柄付き腓骨移植で再建した小児上腕骨軟骨肉腫の1例

Chondrosarcoma of the Humerus in a Child Treated with Tumor Resection and Reconstruction with Vascularized Fibular Graft. Case Report

　小児上腕骨軟骨肉腫に対し，広範切除後に血管柄付き腓骨移植(以下VFG)で再建し，長期に良好な成績を得ている症例を経験した．症例は6歳の女児で，単純X線像で左上腕骨近位に骨腫瘍を指摘され紹介された．生検で内軟骨腫の診断を得て慎重に経過観察をしていたが，徐々に腫瘍の増大，軟部への伸展がみられ軟骨肉腫と考え，広範切除を行い，欠損部をVFGで再建した．術後半年で骨癒合が得られ，徐々に移植骨の肥大もみられた．現在，術後7年で無病で生存し，ISOLS(国際患肢温存学会)の患肢機能評価は自己満足度を除き25点中25点で，日常生活に支障はない．

　We report a rare case of a 6-year-old-girl with chondrosarcoma of the humerus that treated with tumor resection and reconstruction with vascularized fibular graft (VFG).　Radiographs revealed osteolysis with calcification and endosteal scalloping in left proximal humerus.　A pathological diagnosis of enchondroma was made on examination of open-biopsy specimen.　She was followed strictly.　Two years later, the tumor size increased, and a diagnosis of chondrosarcoma was suspected.　We widely resected this tumor and reconstructed with VFG for bone defect.　Bone union was obtained for 6 months after surgery, and grafted bone was enlarged gradually.　Seven years postoperatively she is disease free and functional score according to ISOLS is 25/25 except emotional acceptance.　VFG seems to be a useful method for reconstruction of upper extremity defects after resection of malignant bone tumor in children.