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目的探讨肿瘤型全膝关节假体置换术治疗胫骨近端骨巨细胞瘤的临床效果。方法 15例胫骨近端骨巨细胞瘤患者行胫骨近端瘤段骨广泛切除和肿瘤型全膝关节假体置换手术。其中男9例,女6例。平均年龄39.8(26~62)岁,均为单侧胫骨,左膝8例,右膝7例。按照放射影像学Campanacci’s分级:原发Ⅲ级9例,原发Ⅱ级6例,另3例原发Ⅱ级患者先行肿瘤边缘切除后植入同种异体骨后局部复发。手术采用膝关节前正中纵行切口,或纵“S”形切口切开,所有病例切除活检通道。根据肿瘤的范围,在肿瘤边界外3 cm进行切除。分别于胫骨近端和股骨远端植入大小合适的肿瘤型全膝关节假体,并用骨水泥固定。髌骨不进行置换,把髌韧带止点与假体固定装置以及翻转的腓肠肌内侧头部分肌瓣缝合,并用打断筋膜后网状纵横延展的肌瓣覆盖,把两侧与切口两边的深筋膜缝合,重建伸膝装置。结果所有患者均能较好地耐受手术。手术时间平均(177±24)min,术中出血量平均(593±115)ml,输血量平均(613±160)ml。15例都获32~53个月的随访,没有发生神经血管损伤、感染、深静脉栓塞、假体周围骨折、假体松动和断裂。术后1年患者MSTS功能评价:优5例,良6例,中4例,差1例,优良率73%。伸膝肌力平均4.2(3~5)级,膝关节屈曲平均(98.1±12.4)°,伸膝平均3.3°(0~15)°。结论瘤段骨广泛切除和肿瘤型全膝关节假体置换术治疗胫骨近端骨巨细胞瘤,能较好地恢复膝关节功能,提高患者生活质量。
Objective To investigate the clinical effect of total knee arthroplasty in the treatment of giant cell tumor of proximal tibia. Methods Fifteen patients with proximal giant cell tumor of the tibia underwent extensive resection of the proximal tibial tubercle and tumor-type total knee prosthesis replacement. There were 9 males and 6 females. The average age was 39.8 (26-62) years old, both unilateral tibia, left knee in 8 cases, right knee in 7 cases. In accordance with Radiographic Campanacci’s classification: 9 cases of primary grade Ⅲ, primary grade Ⅱ 6 cases, and the other three cases of primary grade Ⅱ patients with tumor resection margins after implantation of allograft bone local recurrence. Surgical use of the median knee anterior longitudinal incision, or vertical “S ” shaped incision, all cases removed biopsy. Depending on the extent of the tumor, resection was performed 3 cm outside the tumor border. Tumor-like total knee prosthesis was implanted in the proximal tibia and distal femur, respectively, and fixed with bone cement. The patella was not replaced, the patellar ligament only point with the prosthesis fixation device and inverted gastrocnemius medial head part of the muscle flap sutured, and with the interruption of fascia extending longitudinally transverse muscle flap coverage, both sides of the incision on both sides of the deep tendons Suture, reconstruction knee extension device. Results All patients were better tolerated surgery. The average operation time was (177 ± 24) min. The average amount of blood loss during operation was (593 ± 115) ml and the average amount of blood transfusion was (613 ± 160) ml. Fifteen patients were followed up for 32-53 months without neurovascular injury, infection, deep venous thrombosis, peri-prosthesis fractures, prosthetic loosening and rupture. One year after operation, MSTS function evaluation was excellent in 5 cases, good in 6 cases, fair in 4 cases and poor in 1 case, the excellent and good rate was 73%. Muscle extensor muscle strength averaged 4.2 (3 ~ 5), knee flexion averaged (98.1 ± 12.4) ° and extensor knee averaged 3.3 ° (0-15 °). Conclusions The extensive resection of tumor bones and tumor-type total knee prosthesis replacement for the treatment of giant cell tumor of proximal tibia can restore knee joint function and improve the quality of life of patients.