胫骨近端肿瘤假体置换术后伸膝装置重建病例报道并文献复习

Cases report and literature review of extensor mechanism reconstruction after proximal tibia prosthesis arthroplasty

目的比较胫骨近端肿瘤假体置换术后不同方法重建伸膝装置的疗效。方法回顾性分析2012年1月至2014年1月,在我院行胫骨近端肿瘤扩大切除、人工假体置换、伸膝装置重建术的患者,评估术后膝关节功能和并发症情况。检索Pub Med,Springer,Ovid,LWW,EMBASE数据库,关键词为胫骨、肿瘤、关节成形术。将相关文献纳入一并讨论。结果本组伸膝装置重建患者32例,均采用假体重建方式。术后随访中出现伸膝迟滞5例,感染2例。共检索到9篇文献,其中骨肉瘤362例,软骨肉瘤26例,尤文肉瘤21例,骨巨细胞瘤21例,软组织肉瘤25例。经典假体重建272例,自体移植物重建2例,生物重建24例。所有膝关节重建术后发生伸膝迟滞29例、感染39例、韧带断裂24例、肿瘤复发25例、假体重建失败133例。结论伸膝装置重建能有效恢复患者膝关节功能,但术后存在并发症较多。比较不同重建方式,没有哪一种技术表现出明显的优越所在。现今手术更趋于生物性重建来改善功能。

Objective To compare the clinical results of different extensor mechanism reconstruction techniques after proximal tibia prosthesis replacement. Methods From January 2012 to January 2014, the patients who received proximal tibia tumor resection, prosthesis replacement and extensor mechanism reconstruction were enrolled. Joint function and complications were assessed after the surgery. Associated manuscripts were searched in Pub Med, Springer, Ovid, LWW and EMBASE, with the tibia, neoplasm and arthroplasty as the key words. Relevant articles were included and discussed. Results A total of 32 patients met the requirements, who all received prosthesis replacement. Extensor lag was noticed in 5 patients and infection in 2 patients during the follow-up. Nine articles were in accordance with the criteria, including 362 cases with osteosarcoma, 26 cases with chondrosarcoma, 21 cases with Ewing sarcoma, 21 cases with giant cell tumor of bone and 25 cases with soft tissue sarcoma. There were 272 cases receiving traditional prosthesis replacement, 2 cases receiving autograft replacement and 24 cases receiving biological reconstruction. After the surgery, extensor lag was found in 29 cases, infection in 39 cases, ligament rupture in 24 cases, relapse in 25 cases and prosthesis failure in 133 cases. Conclusions With extensor mechanism reconstruction, joint function can be restored but with a lot of postoperative complications. Through the comparison of different reconstruction techniques, no obvious advantages can be found in a single one. Nowadays, biological reconstruction is gaining more and more attention and can be used to improve the function.