定制肿瘤型膝关节假体置换术中软组织修复与重建

发布时间：2018-08-26 20:02

【摘要】：目的:探讨肿瘤型膝关节假体置换术中应用腓肠肌肌瓣进行软组织修复与重建对于治疗胫骨近端恶性肿瘤的临床效果。方法:收集2004年-2012年之间于贵州医科大学附院骨科诊治的胫骨近端恶性骨肿瘤并行定制肿瘤型膝关节假体置换术的患者62人。按照其手术方式的不同,分为A、B两组进行回顾性分析。A组为2004-2008年期间收治的30例,术中未行腓肠肌肌瓣转移覆盖。B组为2009-2012年期间收治的32例,术中行腓肠肌肌瓣转移覆盖。其中骨肉瘤45例,恶性骨巨细胞瘤9例,恶性纤维组织细胞瘤6例,软骨肉瘤2例。Enneking分期IB期4例,IIA期18例,IIB期27例。两组患者在年龄、性别及病理学类型方面差异无统计学意义。比较A、B两组在术后并发症发生率、复发率、死亡率、术后肢体功能评估等方面的差异。肢体功能评估包括客观关节活动度测量和主观Enneking评分两方面。结果:全组62例患者中,男性35例(56.5%),女性27例(43.5%)。年龄15-60岁,平均29.24±8.46岁。在术后并发症发生率方面,术后严格随访24-48个月,平均36.27±7.41月。术后发生并发症为11例,B组仅出现2例(6.2%),明显优于A组9例术后并发症(30%)。全组62例患者在随访期间4例患者出现了肿瘤复发,复发率为6.5%。9例患者出现远处转移,该9例患者均因肿瘤转移导致呼吸循环衰竭死亡,占14.5%。两组在复发率及死亡率方面无显著性差异。术后1年的功能评分方面,B组主观Enneking评分28.44±1.76分,膝关节屈曲客观测量可达135.63±7.80度,均明显优于A组(主观Enneking评分26.70±1.24,膝关节屈曲客观测量106.33±13.6度)。结论:定制肿瘤型膝关节假体置换术是治疗胫骨近端恶性肿瘤的有效方式,其术中利用腓肠肌肌瓣修复其周围软组织,对于降低胫骨近端恶性肿瘤手术并发症及有效发挥人工关节功能起着至关重要的作用,临床上值得广泛推广和应用。
[Abstract]:Objective: to investigate the clinical effect of soft tissue reconstruction with gastrocnemius muscle flap in the treatment of proximal tibia malignant tumor. Methods: 62 patients with malignant tumor of proximal tibia treated by orthopaedics department of affiliated hospital of Guizhou Medical University from 2004 to 2012 were enrolled in this study. According to the different operation methods, the patients in group A were divided into two groups. Group A was treated from 2004 to 2008. Group B was treated with gastrocnemius muscle flap in 20092012, while group B was treated with gastrocnemius muscle flap in the period of 2009-2012. The patients in group A were treated with gastrocnemius muscle flap during the period of 2009-2012. Among them, 45 cases of osteosarcoma, 9 cases of malignant giant cell tumor of bone, 6 cases of malignant fibrous histiocytoma, 2 cases of chondrosarcoma. Enneking stage IB 4 cases, 18 cases of IIA stage II B, 27 cases. There was no significant difference in age, sex and pathological type between the two groups. The incidence of postoperative complications, recurrence rate, mortality rate and postoperative limb function evaluation were compared between the two groups. The evaluation of limb function includes objective joint motion measurement and subjective Enneking score. Results: of the 62 patients, 35 (56.5%) were male and 27 (43.5%) were female. The average age was 29.24 卤8.46 years old. The postoperative complications were followed up for 24-48 months (mean 36.27 卤7.41 months). There were only 2 cases (6.2%) with postoperative complications in group B, which was significantly better than that in group A (9 cases) (30%). The recurrence rate was 6.5.9 cases with distant metastasis. All the 9 patients died of respiratory and circulatory failure due to tumor metastasis, accounting for 14.5%. There was no significant difference in recurrence rate and mortality between the two groups. One year after operation, the subjective Enneking score of group B was 28.44 卤1.76, and the objective measurement of knee flexion was 135.63 卤7.80 degrees, which was significantly better than that of group A (subjective Enneking score 26.70 卤1.24, knee flexion objective measurement 106.33 卤13.6 degree). Conclusion: Tumor-type knee prosthesis replacement is an effective method for the treatment of proximal tibial malignant tumor. Gastrocnemius muscle flap is used to repair the surrounding soft tissue during the operation. It plays an important role in reducing the operative complications of proximal tibia malignant tumor and exerting the function of artificial joint effectively. It is worth popularizing and applying widely in clinic.
【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R738.1

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