胫骨前肌肌筋膜瓣在胫骨肿瘤人工膝关节置换术中的应用

The application of tibialis anterior muscle and deep fascia flap in the treatment of tibial bone tumor with proximal tibial prosthesis

目的 探讨胫骨前肌肌筋膜瓣转位在胫骨肿瘤患者人工膝关节置换术中应用的效果。方法 采用人工膝关节置换术治疗胫骨上段骨肿瘤 3 1例。其中骨巨细胞瘤 1 7例 ,成骨肉瘤 8例 ,软骨肉瘤 4例 ,软骨母细胞瘤 2例。肿瘤切除后 ,沿深筋膜浅层游离外侧缘皮肤达趾长伸肌内缘。沿趾长伸肌与胫骨前肌的间隙切开深筋膜 ,向内游离深筋膜达胫骨前肌外缘 ,切缘的上端向内绕行 ,使胫骨前肌的胫骨侧起端与深筋膜一起游离 ,形成深筋膜及胫骨前肌肌瓣。将此肌筋膜瓣向内翻转 ,覆盖在假体前方 ,与内侧的髌韧带、深筋膜或股薄肌、半腱肌、半膜肌与鹅足缝合 ,形成一肌筋膜袖重新包裹在胫骨侧假体周围 ,然后再缝合皮肤。结果 切口愈合按甲、乙、丙、丁分级。其中 :甲级 2 6例 ,乙级 3例 ,丙级 2例 ,切口一期愈合。关节活动度 :术后 2周 ,0°～ 85°。术后 6周 0°～ 1 1 0°。随访 0 5～ 9 0年 ,局部复发 1例 ,远处转移 5例。结论 胫骨前肌肌筋膜瓣解剖血管恒定 ,血运丰富。采用胫骨前肌肌筋膜瓣向内转移与肌筋膜或深筋膜共同形成一肌筋膜袖重新包裹在胫骨侧假体周围 ,可有效避免胫骨肿瘤患者人工膝关节置换术后近期并发症的发生。

Objective To evaluate the application of tibialis anterior muscle and deep fascia flaps in the treatment of tibial bone tumor with proximal tibial prosthesis.Methods Thirty one patients with proximal tibial tumor were treated with en bloc resection and reconstructed with custom-made knee prosthesis.There were 17 patients with giant cell tumor,8 patients with osteosarcoma,4 patients with chondrosarcoma,2 patients with chondroblastoma.After the prosthesis was placed in situ,anterior tibial muscle and deep fascia flaps were prepared and transferred to cover the tibial prosthesis.Results The wound healing were classified as A/I,B/I,C/I and D/I.The wound was healed as A/I in 26 cases,B/I in 3 cases,C/I in 3 cases,C/I in 2 cases.The average range of motion of the knee was 0°-85° at two weeks postoperatively,and 0°-110° at six weeks postoperatively.All cases were followed up for an average of 2.5 years (0.5-9.0 years).Local recurrence was seen in 1 case,metastasis in lungs was seen in 5 cases.Conclusions The tibialis anterior muscle and deep fascia flaps possess regular vasa vasorum and abundant vascularity.Transferring this flap to cover the tibial prosthesis is a simple and effective way to prevent postoperative early stage complications.