保留半月板的胫骨近端复发性骨巨细胞瘤切除及膝关节重建术

Knee joint reconstruction with preservation of the meniscus after resection of recurrent giant cell tumors of the proximal tibia

目的 :探讨保留半月板、自体髂骨板重建胫骨平台的膝关节重建术对偏一侧髁的胫骨近端复发性骨巨细胞瘤的治疗价值。方法 :对 9例偏一侧髁 (外髁 7例 ,内髁 2例 )的胫骨近端复发性骨巨细胞瘤行保留半月板的肿瘤侧胫骨髁切除术 ,用自体髂骨板在半月板下重建胫骨平台。结果 :随访 2 4～ 5 7个月 ,除 1例再次局部复发而行带胫骨近段的人工膝关节置换术外 ,余 8例均无局部复发。重建的胫骨平台无塌陷 ,植骨愈合满意。膝关节屈伸功能均恢复正常 ,无膝关节不稳或关节疼痛。结论 :该术能够在彻底切除肿瘤的前提下 ,尽可能保留和恢复膝关节的正常解剖结构 ,可作为胫骨近端肿瘤切除后膝关节重建的新的选择术式。

Objective: To evaluate knee joint reconstruction by preserving the meniscus and reconstructing the tibial plateau with iliac plate autograft after resection of recurrent giant cell tumor of the proximal tibia. Methods: Resection of the recurrent giant cell tumor of one tibial condyle was performed in 9 cases (7 lateral and 2 medial condyle). The meniscus of the affected side was preserved and the tibial plateau was successfully reconstructed with iliac plate. Results : The follow up period was 24 to 57 months . Only one case suffered recurrence and received artificial knee joint replacement. No collapse in the reconstructed tibial plateau was seen and the healing of autograft was satisfactory. The function of knee joint in flexion and extension restored to normal, without instability or joint pain. Conclusion: Under the precondition that the tumor should be thoroughly resected, the normal anatomic structures of the knee joint can been preserved or restored as much as possible by the described method which can be used as a new selective procedure in reconstructing knee joint after tumor resection of the proximal tibia.