半腱肌肌腱重建前交叉韧带在恶性骨肿瘤保肢术中的应用

Application of semitendinosus tendon for the reconstruction of anterior cruciate ligament in limb salvage surgery of malignant bone tumors

目的探讨半腱肌肌腱重建前交叉韧带(ACL)在膝关节周围恶性骨肿瘤保肢术中的应用价值。方法回顾性分析2010年7月至2011年4月郑州大学附属肿瘤医院收治的34例膝关节周围恶性骨肿瘤患者的临床资料,患者行保肢术的同时采用同侧肢体半腱肌肌腱单隧道重建ACL。评估患者膝关节活动度和稳定性、膝关节功能及并发症等情况。结果随访时间12～25个月,平均随访时间18个月。术后6个月,6例患者存在轻度屈膝受限,但能满足日常生活能力;28例膝关节活动度正常。术后12个月,33例患者Lachman试验阴性、1例Ι度阳性,术后KT-1000分级较术前明显改善,差异有统计学意义(P<0.05);术后Lysholm评分[(93±4)分]较术前[(65±5)分]明显升高(P<0.05);术后IKDC分级优良级较术前增多(P<0.05)。均未出现膝关节不稳、骨性关节炎及半月板损伤等并发症。结论膝关节周围恶性骨肿瘤侵犯ACL患者保肢术中,使用半腱肌肌腱单隧道重建ACL能够恢复膝关节的稳定性并维持膝关节功能,具有较好的应用价值。

Objective To investigate the clinical value of the ipsilateral semitendinosus tendon for the single-tunnel reconstruction of anterior cruciatc ligament （ACL） in limb salvage surgery of malignant bone tumors around knee joint. Methods A retrospective analysis was done for 34 patients of malignant bone tumors around knee joint treated from July 2010 to April 2011 in the Affiliated Cancer Hospital of Zhengzhou University, who were performed ACL single-tunnel reconstruction in the limb salvage surgery. The postoperative activity, stability and function of knee, as well as the complications were evaluated. Results All patients were followed up from 12 to 25 months （the axerage was 18 months）. At 6 months after surgery, knee activities of 28 cases were normal while there were mild limitation of knee flextion in 6 cases whose knee activity could meet the daily lives. At 12 months after surgery, Lachman tests showed that 33 cases were negative, only 1 patient was positive with I degree, Postoperative KT-1000 grade improved when compared with preoperative one, the difference had statistical significance （P 〈 0.05）; the score of Lysholm test was increased from preoperation （65 ± 5） to postoperation（93± 4）, and the cases of IKDC with excellent degree and good degree were much more than preoperative ones （P 〈0.05）. No complications such as knee instability, osteoarthritis, meniscus injury had happened. Conclusion For the limb salvage surgery of malignant bone tumors around knee joint, ACL single-tunnel reconstruction using ipsilateral semitendinosus tendon is a good way to recover the stability of knee and maintain the function of knee.