游离髌骨移植修复膝部半髁骨缺损手术方法

Reconstruction surgery of knee by using free patella grafts to repair block defects

[目的]探讨髌骨移植对股骨下端或胫骨上端半髁骨缺损修复的治疗效果,提出手术步骤和方法。[方法]本组骨巨细胞瘤患者7例,病史4～12个月,平均5.8个月。男4例,女3例;年龄18～40岁,平均31.8岁。股骨下端4例,胫骨上端3例,按Ennecking外科分期,2期5例,3期2例。用髌骨关节面代替股骨或胫骨髁关节面修复和重建骨缺损。[结果]随访时间3～10年,3例5年以上,平均4.9年。随访期间无复发转移,无髌骨坏死和感染,移植骨愈合良好。根据国际保肢学会功能评分标准,关节功能优3例,良4例。术后主要并发症为关节活动范围减小,范围40°～110°,平均88°。术后伸膝肌力下降不明显,1例胫骨平台轻度下沉,1例于术后6年出现关节疼痛。[结论]膝关节上下侵犯关节软骨的骨巨细胞瘤,行包括肿瘤在内的一侧髁切除后,可以用游离髌骨移植修复和重建骨缺损。

[ Objective] To discuss the clinical results of reconstruction of block bone deficit knee （lower femur and upper tibia） by transplantation of patella and present surgery protocols. [ Methods ] There were 7 patients who have giant cell tumor of bone in the lower femur or upper tibia at the knee in this report. The case history was from 4 to 12 months, average 5.8 months. Four were male and three were female. The age ranged from 18 to 40 years, average 31.8 years. Four had lesions at the lower femur and the other three had lesions at the upper tibia. According to Ennecking grade, five cases were in grade 2 and two cases were in grade 3. When the cartilage of the knee was damaged by bone tumors, the author supplemented it by autogenous patella to fill the defect. [ Results] All cases of patella grafts were presented , with follow-up from 3 to 10 years （ average 4. 9 years）, three cases were followed up more than 5 years. During the follow up, there was no case with recurrence, metastasis or necrosis and infection of graft. All the grafts had good union. According to the function evaluation standard of the international protecting extremities institute, 3 excellent, 4 good. The main complications were less range of movement of the knee （ movement range 40 - 110 degree, average 88 degree） . Weakness of the extensor apparatus was not obvious. One case had slight collapse of tibia plateau and another case sufferd from joint pain 6 years after operation. [ Conclusion] When the cartilage of the lower femur and the upper tibia is damaged by bone tumors, the bone tumors and its affected condyle cowld be incised, then apply patella grafts to repair and reconstruct the defect of the knee.