全股骨的重建——BⅢb型旋转成形术的外科技术和临床结果

Total femur reconstruction(rotationplasty type B Ⅲ b according to Winkelmann)-a unique surgical procedure with a functional outcome

目的探讨BⅢb型旋转成形术治疗下肢恶性肿瘤的临床疗效。方法2017年7月及2018年4月,我院全军骨科中心采用BⅢb型旋转成形术治疗2例病人,1例因“左大腿血管内皮瘤放疗术后股骨感染性骨不连”就诊,行BⅢb型旋转成形术;1例因左大腿脂肪肉瘤入院,肿瘤累及左股骨前群,内侧群及后群肌肉,股血管及股神经包绕,坐骨神经未累及,行BⅢb型旋转成形术进行保肢。采用美国骨肿瘤学会评分系统(M usculoskeletal Tumor Society 93, MSTS 93)、功能性活动评估(functional mobilityassessment, FMA)系统、多伦多下肢功能量表(Toronto extremity salvage score, TESS)、健康调查简表(theMOSitemshortfromhealthsurvey,SF 36)评估治疗效果。结果 1例术后2年功能满意,MSTS93评分为72分,FMA评分为53分,TESS评分为93分,SF 36量表为56分。另1例术后随访1年功能满意,MSTS93评分为63分,FMA评分为47分,TESS评分为88分,SF 36量表为52分。结论 BⅢb型旋转成形术重建髋关节稳定性良好,可获得术后满意功能,适用于一些慎重选择的病人。

Objective To explore the effect of rotationplasty type BⅢb on the treatment of lower extremity malignancies. Methods Two patients were treated with rotationplasty type BⅢb in our hospital from July 2017 to April 2018. For case 1, who was treated for“infective nonunion of radiation-associated pathologic fractures of the femur”, after the relevant examinations, rotationplasty type BⅢb was performed. The case 2 was admitted to the hospital due to left thigh liposarcoma. MRI showed that the tumor involved the left femur anterior group, the medial group and the posterior group muscles, the femoral vessel and nerves were wrapped, the sciatic nerve was not involved, and rotationplasty type B Ⅲ b was performed for limb salvage. The Musculoskeletal Tumor Society 93 (MSTS 93), functional mobility assessment (FMA), Toronto extremity salvage score (TESS) and the MOS item short from health survey (SF-36) were used to evaluate therapeutic effects. Results The case 1 was followed up for 2 years with satisfactory function. The MSTS 93 score was 72, the FMA score was 53, the TESS score was 93, and the SF-36 scale was 56. The case 2 was followed up for 1 year with satisfactory function. The MSTS 93 score was 63, the FMA score was 47, the TESS score was 88, and the SF-36 scale was 52. Conclusion Rotationplasty type BⅢb can reconstruct the stability of hip joint and obtain satisfactory function after operation. It is suitable for some carefully selected patients.