腓肠肌肌瓣转移重建伸膝装置在胫骨近端骨肿瘤保肢中的应用  

The application of gastrocnemius muscle flap transposition for extensor mechanism reconstruction in limb-salvage operation of proximal tibial malignant tumors

作　　者：董扬[1] 白云鹏[1] 张春林[1] 杨庆诚[1] 张智长[1] 朱翔[1] 杜鑫辉[1] 

机构地区：[1]上海交通大学附属第六人民医院骨科,200233

出　　处：《中国骨与关节杂志》2012年第6期615-619,共5页Chinese Journal of Bone and Joint

摘　　要：目的探讨在胫骨近端恶性骨肿瘤保肢手术中,应用腓肠肌肌瓣转移重建伸膝功能的临床效果。方法回顾性分析2007年1月至2011年6月我院收治的胫骨近端恶性骨肿瘤51例,男34例,女17例;年龄12～66岁,平均24.6岁。对所有肿瘤均行扩大性瘤段切除,骨内病灶扩大3cm,软组织肿块外扩大1～2cm,保证完整的肿瘤边界,采用肿瘤型人工膝关节假体置换,并向前、向上旋转腓肠肌肌瓣覆盖胫骨假体表面,将腓肠肌内侧头起点与残留髌韧带近端缝合重建伸膝装置,同时,肌瓣内侧与内侧关节囊残壁、内侧副韧带、部分比目鱼肌及腓肠肌离断远端缝合,肌瓣前侧与部分比目鱼肌和胫前肌缝合,肌瓣外侧与部分胫前肌、部分比目鱼肌和腓肠肌离断远端缝合重建伸膝功能。术后定期随访患者,下肢功能通过MSTS评分系统评价。结果所有患者均获随访,随访时间3-57个月,平均23.7个月。术后未出现伤口感染、深静脉血栓、骨筋膜综合征、膝关节强直等早期并发症。8例(15.7%)骨肉瘤,因肺部广泛转移,于术后18-34个月死亡;3例(5.9%)骨肉瘤术后在软组织内复发,经局部切除术后仍复发,行截肢术。3例(5.9%)迟发性感染,假体取出骨水泥填充。MSTS功能评分为84%(平均分25.2;范围22～29)。膝关节屈曲平均93°(78°～127°),伸膝平均-3°(0°～-10°)。结论胫骨近端瘤段切除假体置换后,应用腓肠肌肌瓣转移与髌韧带缝合既可修复软组织缺损,减少并发症,又可以重建伸膝装置,获得良好的膝关节功能,中短期随访得到较好的临床效果。Objective To investigate the clinical effects of applying gastrocnemius muscle flap transposition for extensor mechanism reconstruction in limb-salvage operation of proximal tibial malignant tumors. Methods Retrospective analysis of 51 patients with proximal tibial malignant tumors who were adopted from January 2007 to June 2011 in our hospital was performed. There were 34 males and 17 females, with a mean age of 24.6 years old （range; 12-66 years）. All tumors underwent extensive or radical tumor resection, and the surgical margin was expanded 3em away from the bone lesions and 1-2cm away from the soft tissue mass to ensure the integrity of the tumor boundary. The tumor type custom-made knee prosthesis was used. The gastrocnemius muscle flap was rotated forward and upward to cover the surface of the tibial prosthesis, and the beginning point of the medial head of the gastrocnemius and the residual proximal patellar tendon were sutured to reconstruct the extensor mechanism. And meanwhile, the medial muscle flap was sutured with the residual wall of the medial articular capsule, the medial collateral ligament, partial soleus muscle and the distal amputated gastrocnemius. The anterior muscle flap was sutured with partial soleus muscle and the tibialis anterior muscle. The lateral muscle flap was sutured with partial tibialis anterior muscle, partial soleus muscle and distal amputated gastrocnemius to reconstruct the extensor mechanism. The patients were followed up regularly after surgery. Musculoskeletal Tumor Society （MSTS） scoring system was used to measure the functional status of patients with Sarcoma in the legs. Results All patients were followed up for a mean period of 23.7 months （range; 3-57 months）. No wound infection, deep venous thrombosis, osteofaseial compartment syndrome, knee joint stiffness and other early complications were found. 8 patients （15.7%） with osteosarcoma died of wide lung metastasis in 18-34 months after surgery; 3 patients （5.9%） with osteosarcoma who had recurren

关 键 词：胫骨近端 骨肿瘤 腓肠肌肌瓣 重建术 

分 类 号：R738.1[医药卫生—肿瘤]