老年膝部复发性软组织肉瘤术后缺损并关节不稳定的修复方法  

Repair method of postoperative defect and joint instability in elderly patients with recurrent soft tissue sarcoma around the knee

作　　者：彭军[1] 马洪良[1] 肖蓉[2] 

机构地区：[1]四川省肿瘤医院骨科,成都市610041 [2]四川省肿瘤医院妇瘤科,成都市610041

出　　处：《中国肿瘤临床》2015年第2期109-111,共3页Chinese Journal of Clinical Oncology

摘　　要：目的:探讨老年膝部复发性软组织肉瘤扩大切除术后膝周软组织缺损并关节不稳定的修复方法和疗效。方法:选择四川省肿瘤医院骨科2009年3月至2014年3月6例符合保肢条件和多次复发的膝周软组织肉瘤老年患者进行有效的术前化疗后,行包括内侧或外侧关节囊壁和侧副韧带在内的扩大切除术,对所形成膝周软组织缺损并关节不稳定,采用Ethibond 5号线重建侧副韧带和(或)部分关节囊壁及联合小腿复合宽蒂筋膜皮瓣或腓肠肌内侧头肌皮瓣修复软组织缺损;对术前、术后即刻及随访6个月时膝关节最大屈曲角度进行观察和统计学检验。结果:获得术中关节即刻稳定和完整覆盖软组织缺损;术前、术后即刻、术后6个月膝关节的最大屈曲角度分别为:(115.0±7.8)°、(101.7±9.3)°、(104.8±10.2)°,其中术前和术后即刻有显著性差异(t=2.68,P<0.05),术后即刻和术后6个月差异无统计学意义(t=0.55,P>0.05)。结论:简单、快速、可靠的膝关节稳定性重建和软组织缺损修复对老年膝部复发性软组织肉瘤患者是适用的。Objective： To evaluate the repair method and its curative effects on defects and joint instability in elderly patients with recurrent soft tissue sarcoma around the knee after wide excision. Methods：Our study included 6 elderly patients with limb sal-vage and effective preoperative chemotherapy. These patients underwent extended resections, including internal or lateral articular cap-sule and collateral ligament excisions. Owing to polyleptic soft-tissue sarcoma around the knee, formed soft-tissue defects, and joint in-stability, collateral ligament and/or partial articular capsule was reconstructed using #5 Ethibond sutures. Simultaneously, soft-tissue de-fects around the knee were repaired by composite-wide pedicled fasciocutaneous flaps or medial head of gastrocnemius muscle flaps of the leg. The maximum flexion angles of the knee （MFKs） were observed and statistically tested before and during surgery, with a fol-low-up period of 6 months. Results： The immediate stability of the joints and complete coverage of the soft tissue defects were achieved during the surgery. The MFKs during preoperative treatment, intraoperative treatment, and six-month follow-up were 115.0° ± 7.8°, 101.7° ± 9.3°, and 104.8° ± 10.2°, respectively, with significant differences between the preoperative and intraoperative MFKs （t=2.68, P0.05）. Conclu-sion：This repair method can be applied to elderly patients with polyleptic soft tissue sarcoma around the knee by using simple, fast, and reliable surgical techniques for the reconstruction, stability, and repair of soft tissue defects in the knee joint.

关 键 词：老年 复发性 软组织肉瘤 缺损 不稳定 修复 重建 

分 类 号：R738.6[医药卫生—肿瘤]