腓肠肌内侧头转移在胫骨近端骨肉瘤保肢治疗中的应用

目的:研究腓肠肌内侧头转移在胫骨近端恶性肿瘤(骨肉瘤)保肢治疗中的应用价值。方法:10例胫骨近端恶性肿瘤(骨肉瘤)广泛切除后利用人工假体重建骨和关节,同时用局部带血管蒂的腓肠肌内侧头转移重建软组织缺损,并与髌韧带止点缝合重建伸膝装置,术后一周给予近距离后装放疗,2周后开始规律化疗。随访时间6～21个月,平均13个月。最终结果按Enneking标准评估。结果:与即往11例无腓肠肌肌瓣转移的保肢病例相比,本组10例病人切口全部一期愈合,有效地避免了切口并发症,患肢功能提高,假体表面皮肤移植性好。结论:带血管蒂的腓肠肌内侧头转移用于胫骨近端骨肉瘤保肢术中,能降低伤口并发症,并有助于患肢功能恢复。

The Application of Medial Head of Gastrocnemius in the Limb Salvage Surgery in the Proximal Tibia with Osteosarcomas

Objective: To study the application value of medial head of gastrocnemius in the limb salvage surgery in the proximal tibia with osteosarcoma. Methods: Limb salvage for the osteosarcoma involves three phases: (1) wide resection of the tumor, (2) reconstruct ion of bone and joint defect by prosthesis, and (3) reconstruction of the soft tissue by muscular flap with or without vascular pedicle. The third phase is very important to cover the prosthesis. Ten patients with osteosarcoma in proximal tibia were treated by limb salvage surgery. All were performed soft tissue reconstruction by application of medial head of gastrocnemius muscle transposition flap, which reconstructs the defect of soft tissue and extensor apparatus by suturing it to the end point of patellar. Results: The wound if all the 10 patients healed by first intention with excellent soft - tissue cover, without any complications in spite of preoperative chemotherapy and postoperative brachytherapy. They got better limb function and more skin movement. Conclusion: The application of medial head of gastrocnemius muscular flap transposition with vascular pedicle in the limb salvage to the osteosarcoma in proximal tibia can decrease the morbidity at the wound and help to restore the limb function.