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[目的]探讨内侧腓肠肌瓣前移在胫骨上段骨肿瘤保肢手术中重建伸膝装置的临床价值与疗效。[方法]2004年4月~2010年1月,对23例胫骨上段恶性或侵袭性骨肿瘤患者行保肢手术同时应用“腓肠肌瓣前移+髌腱固定”重建伸膝装置。男16例,女7例。年龄10~76岁,平均27岁。骨肉瘤12例,骨巨细胞瘤9例,滑膜肉瘤1例,骨恶性纤维组织细胞瘤1例。23例中行瘤段灭活再植术11例,瘤段切除肿瘤型旋转铰链膝关节假体置换术7例,灭活自体骨复合肿瘤假体置换术5例。术后采用MSTS评分系统评价患肢功能。[结果]所有患者均获随访,平均28个月(3~63个月)。除1例因肺转移死亡外,余22例患肢功能评分为19~28分,平均24分。3例术后出现暂时性腓总神经麻痹;3例出现皮肤坏死、窦道渗液,经植皮、抗感染治疗后痊愈。[结论]胫骨上段骨肿瘤保肢手术治疗时以“腓肠肌瓣前移+髌腱固定”重建伸膝装置,可以实现生物性重建,有利于患膝功能恢复,降低感染、皮肤坏死等并发症的发生率。
[Objective] To investigate the clinical value and curative effect of medial gastrocnemius flap anterior extension in the reconstruction of knee extensor device in limb salvage surgery of the upper tibial bone tumors. [Methods] From April 2004 to January 2010, 23 patients with malignant or invasive bone tumors in the upper tibia underwent limb salvage surgery and “knee gastrocnemius flap + patellar tendon fixation” reconstruction knee extensor device. 16 males and 7 females. Ages 10 to 76 years old, average 27 years old. 12 cases of osteosarcoma, 9 cases of giant cell tumor of bone, 1 case of synovial sarcoma, 1 case of malignant fibrous histiocytoma. Twenty-three cases of in-tumor tumor inactivation and replantation were performed in 11 cases. Tumor resection was performed in 7 cases of tumor-type revolute knee prosthesis replacement. Inactivated autologous bone tumor replacement was performed in 5 cases. MSTS score system was used to evaluate limb function. [Results] All patients were followed up for an average of 28 months (range 3 to 63 months). Except 1 patient died of lung metastasis, the remaining 22 limb functional scores were 19 to 28 with an average of 24 points. 3 cases of temporary peroneal nerve paralysis occurred after surgery; 3 cases of skin necrosis, sinus exudate, the skin graft, anti-infective treatment recovered. [Conclusion] Reconstruction of knee extensor device with “gastrocnemius flap advancement + patellar tendon fixation” during the limb salvage surgery of the upper tibial bone tumors can be used to reconstruct the extensor, which is good for the recovery of knee function, reduction of infection and skin necrosis. The incidence of disease.