腓肠肌及比目鱼肌瓣在胫骨近端恶性骨肿瘤保肢术的应用

目的　探讨带血管蒂腓肠肌、比目鱼肌肌瓣移植在胫骨近端恶性骨肿瘤保肢术中的应用价值。方法　行胫骨近端恶性骨肿瘤保肢术患者共 2 6例 ,其中行腓肠肌、比目鱼肌肌瓣移植 16例 ,未行肌瓣移植 10例。结果　肌瓣移植者中有 1例发生肌瓣坏死及骨筋膜室综合征 ;非移植者中有 2例发生切缘皮瓣坏死深部感染 ,3例切口脂肪液化浅表感染。 19例术后平均随访 38个月 ,按Enneking法评定功能 ,≥ 2 3分 6例 ,15～ 2 2分 8例 ,<15分 5例 ,优良率为 73.7%。结论　胫骨近端骨恶性肿瘤保肢术中采用带血管蒂腓肠肌、比目鱼肌肌瓣移植可重建软组织缺损、降低局部并发症及提高临床疗效。

Application of gastrocnemius, soleus muscle flap in limb salvage for proximal tibial malignant tumor

Objective To evaluate the vascularised gastrocnemius, soleus muscle flap grafting in limb salvage for proximal tibial malignant tumor. Methods Limb salvage surgery was performed in 26 patients with proximal tibial malignant tumors. 16 of them underwent gastrocnemius, soleus muscle flap grafting, while the others did not. Results There were 1 flap necrosis and osteofascial compartment syndrome in the flap grafting group, and 2 skin necrosis at the margin of incision with deep infection, 3 fat liquefaction and superficial infection in non grafting group. 19 patients were followed up for 14 to 97 months (average 38 months). The function was assessed by Enneking system. The score was above 23 in 6 cases, between 15 and 22 in 8 and below 15 in 5. Good and excellent rates were 73.7%. Conclusion The vascularised flap grafting of gastrocnemius, soleus muscle can reconstruct the soft tissue defect, decrease the rate of local complication and improve the clinical outcome of limb salvage for proximal tibial malignant tumor.