髌骨和髂骨移植修复膝部骨巨细胞瘤致大块骨缺损

Using patella and iliac bone grafts to repair the bone defects of the knee joint due to giant cell tumor

目的探讨髌骨和髂骨移植对股骨下端和胫骨上端大块骨缺损修复的治疗效果。方法股骨下端和胫骨上端骨巨细胞瘤患者14例，男8例，女6例；年龄20-42岁，平均33．9岁；病史2-12个月，平均5．6个月；股骨下端6例，胫骨上端8例。按Enneeking外科分期，2期11例，3期3例。游离髌骨移植8例，带肌蒂髌骨移植2例，髂骨移植4例。股骨和胫骨肿瘤侵犯一侧髁软骨面时用游离或带肌蒂髌骨移植，胫骨肿瘤同时侵犯髁间部时用髂骨移植，修复和重建膝关节部骨缺损。结果随访时间3个月-11年，平均4．5年。根据国际保肢学会功能评分标准，优3例，良8例，可2例，差1例。游离髌骨移植者关节功能较好。术后主要并发症为关节活动范围减小（活动范围，40°-120°，平均82°），关节不适，肌力下降，疼痛。带肌蒂髌骨移植者术后伸膝肌力有不同程度地下降，但随着时间的延长有一定的恢复。游离髌骨移植者术后伸膝肌力下降不明显。髂骨移植患者术后关节退行性改变明显。结论膝关节周围骨巨细胞瘤侵犯关节软骨时，行包括肿瘤在内的股骨或胫骨一侧髁切除后，可以用髌骨和髂骨移植修复和重建骨缺损。

Objective To discuss the clinical results ot patella and lilac autogenous gratts to repair the bone defects at knee joint （lower femur or upper tibia）. Methods From 1992, 14 patients suffered bone giant cell tumor in the lower femur or upper tibia were analyzed retrospectively. There were 8 males and 6 females,with the mean age of 33.9 years （ranged from 20 to 42 years）. The mean period of onset was 5.6 months, ranged from 2 to 12 months. According to Ennecking classification, there were 11 patients for grade Ⅱ and 3 patients for gradeⅢ. Eight cases underwent free patella transplantation, two cases underwent transplantation of patella with vascular muscle pedicle, the other 4 cases underwent transplantation of iliac bone. For the unilateral femoral or tibial condyle invaded by giant tumors, autogenous patella or associated with muscle flap was grafted to repair the bone defect. For the tumor invaded tibial intercondylar of the knee joint, the iliac bone graft was performed to repair the defect and reconstruct the knee function. Resuits All 14 patients were followed up from 3 months to 11 years （average 4.5 years）. According to the function evaluation standard of the international protecting extremities institute, 3 excellent （transplantation of free patella）, 8 good, 2 fair, 1 worse. The patients performed transplantation of free patella all got excellent genicular function. The main complications were limited range of movement of the knee（movement range 40- 120 degree, average 82 degree）, weakness of the extensor apparatus and discomfort of joint while the patients using a patella graft with a vascular muscle pedicle and obvious joint degeneration after using the iliac bone grafts. Conclusion When the cartilage of the lower femur and the upper tibia was damaged by bone tumors, we could incise the bone tumors and its affected condyle, then apply patella grafts and iliac bone grafts to repair and reconstruct the defect of the knee.