膝部肿瘤切除后关节功能重建的方法分析

Analysis of methods of functional reconstruction of knee joint after resection of tumor round the knee.

目的 探讨膝部肿瘤切除后关节功能重建的方法选择和疗效。方法 54例膝关节周围肿瘤中,骨巨细胞瘤25例,非骨化性纤维瘤2例,成纤维性纤维瘤2例,动脉瘤样骨囊肿1例,软骨黏液性纤维瘤2例,骨肉瘤15例,软骨肉瘤2例,恶性纤维组织细胞瘤5例。23例采用瘤体切除,吻合血管的自体髂骨、腓骨联合移植术,12例瘤段切除灭活再植术,19例瘤段切除人工假体置换术。结果 54例平均随访5年6个月,成活病例术后功能评价优良率为76％。结论 膝部肿瘤切除后关节功能的重建,应根据肿瘤的大小、包壳的完整性、软组织的侵及情况,以及肿瘤的病理组织学性质,选择适当的手术方法。瘤体切除,吻合血管的自体髂骨、腓骨联合移植术,是治疗膝关节周围良性侵袭性肿瘤或低度恶性肿瘤较为理想的方法。

Objective To explore the methods of functional reconstruction of the knee joint after resection of tumor round the knee and their curative effects. Methods Of 54 patients with tumor round the knee, there were 25 cases of giant cell tumor of bone , 2 of nonossifying fibroma, 2 of desmoplastic , 1 of aneurysmal bone cyst, 2 of chondromyxoid fibroma, 15 of osteosarcoma, 2 of chondrosarcoma and 5 of malignant fibrohistiocytoma. The surgical procedures consisted of concomitant use of anastomotic and vascularized ilia bone autografts and fibula autografts after resection of tumor body in 23 knees, inactivated reimplantation after resection of tumor segment in 12 knees, and artificial prosthesis replacement after resection of tumor segment in 19 knees. Results The average followup of 54 patients was 5 years and 6 months, good and very good results were achieved in 76% cases for functional evaluation. Conclusion The methods of functional reconstruction of knee joint after resection of tumor round the knee should according to the size of tumor, integrality of shell, invasion of soft tissue and property of histopathology of tumor. Resection of tumor body and concomitant use of anastomotic and vascularized iliac bone autografts and fibula autografts are ideal methods for benign invasive tumor or low malignant tumor round the knee joint.