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目的 :探讨腓肠肌内侧头前移术在预防胫骨上端恶性骨肿瘤保肢术后切口愈合问题中的价值。方法 :在对 2 0例胫骨上端恶性骨肿瘤患者行保肢术的同时行腓肠肌内侧头前移术。骨肉瘤 12例 ,骨巨细胞瘤 6例 ,尤文肉瘤和恶性纤维组织细胞瘤各 1例。瘤段切除特制人工关节置换术 14例 ,瘤段切除灭活骨再植术 6例。结果 :本组患者除 1例患者术后胫骨前部皮肤坏死 ,经清创后行游离植皮而愈合外 ,余 19例患者术后切口均1期愈合 ,3例出现后期切口渗出及裂开。 18例获得随访 ,2例骨肉瘤死亡 ;术后肢体功能优 4例 ,良 7例 ,可2例 ,差 5例。结论 :腓肠肌内侧头前移术应成为胫骨上端恶性骨肿瘤保肢术的一个重要组成部分 ,对于预防切口问题的发生具有重要的意义。
Objective: To investigate the value of medial medial head gastrocnemius muscle in the prevention of incision healing after limb salvage surgery in the upper tibia. Methods: Twenty patients with malignant bone tumors in the upper tibia were treated with limb salvage while the medial head of gastrocnemius was performed. Osteosarcoma in 12 cases, giant cell tumor in 6 cases, Ewing sarcoma and malignant fibrous histiocytoma in 1 case. Tumor resection of special artificial joint replacement in 14 cases, tumor resection inactivated bone replantation in 6 cases. Results: All the patients except one patient had postoperative necrosis of the anterior tibial shaft and were healed by free skin graft after debridement. All the 19 cases were healed by one-stage incision and three cases had exudation and dehiscence . Eighteen cases were followed up and 2 cases died of osteosarcoma. The postoperative limb function was excellent in 4 cases, good in 7 cases, fair in 2 cases and poor in 5 cases. Conclusion: The medial head gastrocnemius should be an important part of the limb salvage surgery for malignant bone tumors in the upper tibia, which is of great significance in preventing incision problems.