膝关节旋转成形术治疗儿童股骨骨肉瘤

目的：介绍并讨论膝关节旋转成形术治疗股骨骨肉瘤的方法和随访结果。材料和方法，对4例股骨远端的骨肉瘤患儿施行了肿瘤广泛局部切除，膝关节旋转成形术，其中女1例，男3例，平均年龄10岁，平均随访3年。结果：目前所有病例均成活，肿瘤局部无复发，术后佩戴义肢，下肢的负重和运动功能好。结论：踝关节代替膝关节旋转成形术对于膝关节周围的原发恶性肿瘤、肿瘤术后局部复发等也是另一种有效的手术治疗方法。     

Long-term follow-up of patients with rotationplasty

Introduction and importanceRotationplasty considered a limb-salvage procedure and has a lot of advantages when comparing it with endoprostheses or above-knee amputation.Case presentationWe report two cases of young patients with osteosarcoma with rotationplasty being performed for both of them.Clinical discussionPatients with rotationplasty have less restrictions in daily life activities due to pain comparing with patients with endoprostheses.ConclusionOur aim here is to confirm that rotationplasty is an applicable, successful and alternative procedure to endoprostheses or above-knee amputation, when doing it based on an accurate indication and patients regain their previous daily life activities and satisfaction.     

旋转成形术治疗股骨与胫骨上端恶性肿瘤(16例报告)

目的：探讨应用旋转成形术治疗股骨与胫骨上端恶性肿瘤的疗效。方法：回顾分析我院收治的下肢恶性肿瘤16例，包括股骨远端13例，股骨近端2例，胫骨上端l例。病理诊断：骨肉瘤9例，骨纤维肉瘤2例，恶性纤维组织细胞瘤2例，滑膜肉瘤、腺泡状肉瘤与骨巨细胞瘤Ⅱ～Ⅲ级各l例。外科分期：EnnekingⅡb期15例，Ib期l例。手术方式：按Winkelmann的分型，A1型13例，A2型l例，B1型2例。结合术前术后化疗6例，放疗2例。结果：全部病例无l例术中死亡，有15例经随访12个月—10年2个月，平均5年4个月，存活最短12个月，最长10年以上。2年内因肺转移死亡4例，2年以上存活ll例，生存率73．3％，5年以上仍健在7例，生存率46．6％，其中有l例术后7年局部复发，再行局部切除。本组共复发2例，复发率13．3％。所有病人存活期间安装小腿假肢后，行走功能满意。结论：旋转成形术治疗股骨与胫骨上端恶性肿瘤，不但可获得较好的疗效，较低的复发率，具有保留或复建髋、膝关节功能的作用，能更好的负重，而且无患肢痛等优点。     

Characteristics and outcome of infections associated with tumor endoprostheses

Introduction: Infection associated with prosthesis used after tumor resection is a common and serious complication. The purpose of the current retrospective study was to describe the course of infection in patients with a tumor endoprosthesis and the determination of risk factors associated with failed limb salvage. Material and Methods: 30 patients with an infection associated with a tumor endoprosthesis were investigated with regard to treatment strategies, number and type of revision operations, duration of hospital stay, determination of risk factors associated with failed limb salvage and final outcome. Results: Limb salvage related to the complication infection was achieved in 19 patients (63.3%). Two-stage reimplantation of an endoprosthesis was successful in 14 patients but subsequently failed in one patient. Out of 11 patients where limb salvage failed, an amputation was performed in 6 patients, a rotationplasty in 4, and stump lengthening procedure in 1 patient. A poor soft tissue condition was a significant (P<0.05) risk factor for failed limb salvage. No patient receiving chemotherapy with a poor soft tissue condition had limb salvage surgery. The mean number of revision operations per patients was 2.6. The mean duration of hospital stay was 68 days. Conclusion: Infection associated with prosthesis is a serious complication and is involved with long hospitalization. Limb salvage failed mostly in the case of a poor soft tissue condition. In these cases repeated revision surgery should be avoided and ablative surgery recommended at an early stage. Rotationplasty is an alternative to amputation in the case of an infection of the proximal or distal part of the femur.     

全股骨的重建——BⅢb型旋转成形术的外科技术和临床结果

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（Musculoskeletal Tumor Society 93, MSTS 93）、功能性活动评估（functional mobility assessment, FMA）系统、多伦多下肢功能量表（Toronto extremity salvage score, TESS）、健康调查简表（the MOS item short from health survey, SF-36）评估治疗效果。结果 1例术后2年功能满意,MSTS 93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,MSTS 93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。     

Rotationplasty (Borggreve/Van Nes and modifications) as an alternative to amputation in failed reconstructions after resection of tumours around the knee joint

Failure of reconstructions as a result of infective or aseptic loosening and massive bone loss may make amputation necessary. If neurovascular structures can be preserved to keep a functional foot, rotationplasty may be considered an option. Four patients treated for malignant bone tumours (two osteosarcomas, one Ewing sarcoma, and one malignant fibrous histiocytoma) of the proximal tibia and distal femur (n=2 each) at the ages of 13 to 21 years had reconstructions that failed 3, 4, 5, and 15 years later. In three patients the cause was intractable infection, and in one loosening with shortening and deficiency of the extensor mechanism. The patients had the option to contact patients who had had rotationplasty as the primary procedure for tumours or severe femoral deficiencies. In two patients an AI-type rotationplasty was done, in one a type AII rotationplasty, and in the fourth a modification with shortening of the lower leg but retention of the knee joint. There were no postoperative complications such as persisting infections, fractures, or pseudarthrosis. All patients are active and are able to go alpine skiing or snowboarding. The main advantage of procedures in which a sensory-motor functional foot is retained is to avoid neuroma pain or phantom sensations. The foot allows for active knee movement of the orthoprosthesis and full weight bearing. It is of great psychological help for the patients to have contact during the decision-making with patients who have had similar procedures. It should be considered as an alternative to amputation.