内侧腓肠肌瓣前移在重建胫骨上段骨肿瘤保肢术伸膝装置中的应用与临床疗效  

The application and clinical outcome of extensor mechanism reconstruction using medial gastrocnemius flap in limb-salvage treatment for bone tumor in the proximal tibia

作　　者：许宋锋[1] 于秀淳[1] 徐明[1] 宋若先[1] 付志厚[1] 

机构地区：[1]济南军区总医院骨病科,济南250031

出　　处：《中国矫形外科杂志》2011年第14期1162-1166,共5页Orthopedic Journal of China

摘　　要：[目的]探讨内侧腓肠肌瓣前移在胫骨上段骨肿瘤保肢手术中重建伸膝装置的临床价值与疗效。[方法]2004年4月~2010年1月,对23例胫骨上段恶性或侵袭性骨肿瘤患者行保肢手术同时应用＂腓肠肌瓣前移＋髌腱固定＂重建伸膝装置。男16例,女7例。年龄10~76岁,平均27岁。骨肉瘤12例,骨巨细胞瘤9例,滑膜肉瘤1例,骨恶性纤维组织细胞瘤1例。23例中行瘤段灭活再植术11例,瘤段切除肿瘤型旋转铰链膝关节假体置换术7例,灭活自体骨复合肿瘤假体置换术5例。术后采用MSTS评分系统评价患肢功能。[结果]所有患者均获随访,平均28个月（3~63个月）。除1例因肺转移死亡外,余22例患肢功能评分为19~28分,平均24分。3例术后出现暂时性腓总神经麻痹;3例出现皮肤坏死、窦道渗液,经植皮、抗感染治疗后痊愈。[结论]胫骨上段骨肿瘤保肢手术治疗时以＂腓肠肌瓣前移＋髌腱固定＂重建伸膝装置,可以实现生物性重建,有利于患膝功能恢复,降低感染、皮肤坏死等并发症的发生率。[Objective] To assess the clinical outcome of extensor mechanism reconstruction using medial gastrocnemius flap in limb-salvage treatment for bone tumor in the proximal tibia.[Method] A total of 23 patients underwent a limb-salvage procedure from April 2004 to January 2010 with medial gastrocnemius flap transposition and patellar tendon fixation,including 16 males and 7 females,with the average age of 27 years（range,10 to 76 years）.Twelve patients were diagnosised as osteosarcoma,9 bone giant cell tumor,1 synovial sarcoma,1 malignant fibrous histiocytoma of bone.Eight patients were operated on with reimplantation of alcohol-deactivated autograft,7 with rotating hinge knee arthroplasty,5 with rotating hinge knee arthroplasty combined with alcohol-deactivated autograft,2 with preservation of epiphysis or joint and reimplantation of alcohol-deactivated autograft,and 1 with curettage and bone cement filling.After operation,the Musculoskeletal Tumor Society（MSTS） score was used to evaluate the recovery of their corresponding functions.[Result]According to the mean follow-up of 28 months（3 to 63 months）,the mean MSTS score was 24（19 to 28）.One patient died of pulmonary metastases,2 patients underwent cutaneous necrosis and sinus tract respectively,1 patient underwent red swelling in leg,who were fully recovered after skin grafting and anti-infective therapy.One patient underwent knee arthroplasty for tumor.[Conclusion] The clinical application of medial gastrocnemius flap transposition and patellar tendon fixation in limb-salvage treatment for bone tumor in the proximal tibia showed that it could achieve biological reconstruction,benefit the stability of the knee joint and function recovery,reduce the incidence of infection and skin necrosis.

关 键 词：骨肿瘤 腓肠肌瓣 髌腱 伸膝功能 膝关节置换 酒精灭活 

分 类 号：R738.1[医药卫生—肿瘤]