中国组织工程研究

中国组织工程研究 ›› 2010, Vol. 14 ›› Issue (17): 3050-3053.doi: 10.3969/j.issn.1673-8225.2010.17.003

• 人工假体 artificial prosthesis • 上一篇    下一篇

腓肠肌内侧头旋转覆盖胫骨近端肿瘤假体重建伸膝装置

徐建强，张伟滨，万  荣，郝  平，杨耀琦，丁晓毅   

  1. 瑞金医院骨科病房，上海市 200025
  • 出版日期:2010-04-23 发布日期:2010-04-23
  • 作者简介:徐建强☆，男，1965年生，浙江省斳县人，汉族，1998年上海第二医科大学毕业，博士，副主任医师，主要从事骨肿瘤方面的研究。 13788900159@139.com

Gastrocnemius muscle transfer for soft-tissue coverage and extensor mechanism reconstruction for limb-sparing resection of the proximal tibia 

Xu Jian-qiang, Zhang Wei-bin, Wan Rong, Hao Ping, Yang Yao-qi, Ding Xiao-yi   

  1. Ward of Orthopeadics Department, Ruijing Hospital, Shanghai  200025, China
  • Online:2010-04-23 Published:2010-04-23
  • About author:Xu Jian-qiang☆, Doctor, Associate chief physician, Ward of Orthopeadics Department, Ruijing Hospital, Shanghai 200025, China 13788900159@139.com

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摘要：

背景：胫骨近端是骨肉瘤第二个好发部位，由于其缺乏肌瓣的解剖特点，保肢手术后容易使重建的假体直接暴露于皮瓣下，缺乏合适的软组织覆盖，引起皮瓣坏死、感染发生。
目的：观察胫骨近端骨肉瘤瘤段切除后，腓肠肌内侧头旋转覆盖软组织缺损，重建伸膝装置的效果。
方法：纳入2001-01/2008-06经病理确诊的胫骨近端骨肉瘤患者27例，按Enneking分期均为ⅡB期。采用骨肉瘤的新辅助化疗方法(Bacci,IOR/OS-N4)治疗后，切除瘤段，定制假体重建，采用内侧带蒂腓肠肌肌瓣旋转覆盖缺损软组织并重建伸膝装置的保肢方法。按MSTS评分评估治疗效果。
结果与结论：平均随访期53.1个月。27例患者中2例(7%)因肺转移在重建后2年内死亡；1例(4%)因重建后感染，最终行截肢术。24例保肢成功的存活患者未发生肿瘤复发及肺转移，MSTS评分平均25.1分。结果提示采用瘤段切除，定制假体重建，内侧带蒂腓肠肌肌瓣旋转覆盖缺损软组织并重建伸膝装置的保肢方法，结合新辅助化疗治疗胫骨近端骨肉瘤，近期重建效果良好，是一个可行的方法。

关键词: 假体重建, 成骨肉瘤, 胫骨, 肌瓣, 腓肠肌, 保肢

Abstract:

BACKGROUND: The proximal tibia is the second common site for primary bony sarcomas, which lacks adequate soft tissue coverage. Resection and reconstruction by any technique leave the reconstructed area in a subcutaneous position. This has been a major source of necrosis of skin and infections.
OBJECTIVE: To observe the effect of gastrocnemius muscle transfer to obtain soft-tissue coverage and extensor mechanism reconstruction for limb-sparing resection of the proximal tibia with endoprosthetic reconstruction.
METHODS: From January 2001 to June 2008, 27 patients with osteosarcoma of the proximal tibia confirmed by biopsy were selected. All the tumours were assigned to stage IIB based on Enneking’s classical staging system. Neoadjuvant chemotherapy (Bacci，IOR/OS-N4) was utilized for the patients. All the patients adopted limb-sparing surgery, i.e. resection of proximal tibia with endoprosthetic reconstruction. A gastrocnemius flap was utilized to improve implant coverage and enhance the patellar tendon repair. MSTS was used to measure the functional status of patients with a sarcoma in the leg.
RESULTS AND CONCLUSION: The follow-up was averagely 53.1 months. Of 27 patients, 2 cases (7%) died of lung metastasis within 2 years, 1(4%) suffered from amputation due to infection and underwent amputation. The others developed no complications or recurrence. The MSTS score was averagely 25.1 points. Results show that resection with endoprosthetic reconstruction utilizing a gastrocnemius muscle flap for osteosarcoma of the proximal tibia is reliable and predictable in combination with neoadjuvant chemotherapy.

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