定制铰链型人工全膝假体在膝部恶性骨肿瘤保肢治疗中的临床应用

目的 探讨＂肿瘤扩大切除＋定制铰链型人工全膝假体结合腓肠肌内侧头肌瓣转移重建术＂在膝部恶性骨肿瘤保肢中的应用和疗效.方法 自2001年10月至2006年7月共治疗15例膝部恶性肿瘤患者.14例接受这种手术治疗,1例因术中发现肿瘤侵犯腘血管难以彻底切除而改行截肢术.骨肉瘤患者术前均接受静脉化疗或动脉灌注化疗,术后继续静脉化疗.评价术后临床结果,包括术后疗效、生存情况、功能状况、术后并发症及处理.结果 所有患者随访8～66个月（平均34个月）.早期并发症包括胫骨上段深部血肿1例,足背及小腿外侧麻木1例和踝关节背伸受限3例.随访中有1例因肺部转移死亡,1例腹腔转移仍带瘤生存,1例局部复发行截肢术,最终保肢率85.7%（12/14）.结论 此手术可改善膝部恶性骨肿瘤患者的早期生活质量、减少致残率,严重手术并发症少,患者术后功能、效果较满意.

Clinical application of specially made prosthetic replacement in extremity salvage treatment of patients with knee malignant bone tumors

Objective To explore and analyse the application and clinical outcomes of extensive tumor resection and reconstruction with specially made hinged total knee prosthesis combined with medial gastrocnemius transposition flap in extremity salvage treatment of patients with knee malignant bone tumors.Methods A total of 15 consecutive patients with knee malignant tumor were reviewed.14 cases underwent extensive tumor resection and reconstruction with specially made hinged total knee prosthesis combined with medial gastrocnemius transposition flap and 1 case had to undergo amputation because of popliteal vascular invaded by tumor found by intraoperetive exploration.Chemotherapy was used in all osteosarcoma patients.The postoperative effects,extremity function,complication and its management were analysed.Results All cases were followed-up from 8 to 66 months(mean,34 m).The postoperative complications included 1 deep haematoma,1 skin numbness located at lateral foot and leg and 3 decreased ankle dorsal muscle strength.At final follow-up,1 case died because of lung metastasis,1 case underwent amputation because of local recurrence and 1 celiac metastasis but still alive.Extremity salvage rate was 85.7%(12/14).Conclusions It is an effective method for extremity salvage treatment of patients with knee malignant bone tumors,and it is convenient to improve life quality and reserve low extremity function.