旋转成形术对骨肿瘤保肢的临床应用

Knee rotationplasty after resecting of bone tumors in distal femur

目的:探讨旋转成形术应用于骨肿瘤保肢的方法与临床解剖学。方法:1992年7月至2002年7月共收治7例,其中股骨下段骨肉瘤5例,软骨肉瘤1例。恶性骨巨细胞瘤1例,年龄18～28岁,平均年龄22岁。全部病例均行大腿中下段瘤段截除,仅保留坐骨神经,然后小腿旋转上移再植,以踝代膝,小腿上端分别用钢板、髓内钉及DHS内固定。肿瘤病人均行正规的术前后化疗。结果:所有患者均随访,平均随访时间28个月,无肿瘤复发。术后可早期下地活动,8周后安装假肢可扶拐基本正常行走与下蹲并能参加轻体力劳动。结论:旋转成形术应用于骨肿瘤保肢有以下特点:(1)可以达到完整根治性切除肿瘤的目的;(2)用功能良好的小腿代替大腿,向后旋转180°的踝关节代替膝关节;(3)术后安装假肢方便容易及轻便,可保留较好的下肢功能。

To discuss the clinical anatomy and limb salvage method for knee rotationplasty after resecting of bone tumors in distal femur. Methods: From July 1992 to June 2002, seven cases of bone tumors in distal femur were treated by the method of knee rotationplasty after resecting of bone tumors. The patients'age ranged from 18 to 21 years old (average of 22). Five cases were osteosarcoma, 1 case was chondrosarcoma and the other cases bone gaint cell tumor of Ⅲ grade. After resecting mid and distal femur including bone tumor and reserving sciatic nerve intact, the ankle was rotated 180 degrees to reconstruct the knee, while femur and tibia were fixed by plate, imtramedullary nail or dynamic hip screw (DHS). Regular chemotherapy was received in all patients of malignant tumors preoperatively and postoperatively. Results: All patients could do practice without limitation in bed and had no local relapse or metastasis during the follow-up period of 28 months. An excellent or good lower extremity functions were obtained by using artificial limbs after 8 weeks postoperatively. Conclusions: It is an effective method to completely resect distal femur tumers for limb salvage, and it is convenient to install artificial limb for reserving lower extremity function as much as possible by using knee rotationplasty after bone resection.