摘要
目的探讨吻合血管的腓骨、髂骨联合移植修复膝关节周围骨巨细胞瘤扩大切除的方法及疗效。方法1996年10月~2002年11月,收治膝关节周围骨巨细胞瘤25例,其中17例采用肿瘤扩大切除,吻合血管的腓骨、髂骨联合移植术,年龄18~44岁。Enneking分期均为A期;放射影像学Campanicci’s分级级11例,级5例,级1例;病理学Jaffe's分级级9例,级7例,级1例。骨缺损范围为5.0cm×4.0cm^8.0cm×5.5cm,采用胫骨近端肿瘤扩大切除吻合血管的腓骨、髂骨联合移植修复肿瘤切除后骨缺损9例,股骨远端肿瘤扩大切除吻合血管的腓骨、髂骨联合移植修复重建肿瘤切除后骨缺损8例。随访观察术后植骨愈合、肿瘤复发情况、膝关节功能以及死亡情况。结果术后17例移植髂骨4.0cm×4.0cm^5.0cm×5.0cm,移植腓骨长度14~20cm,伤口期愈合。均获随访26~87个月,平均54个月。所有移植骨术后均愈合,愈合时间75~120d,平均93d。术后复发2例,关节腔间隙轻度狭窄3例。所有患者膝关节屈伸功能良好,其中股骨远端重建后屈曲80~105°,平均96°;胫骨近端重建后屈曲90~120°,平均110°。根据Enneking下肢功能评价标准,优11例,良3例,可1例,差2例,优良率为82.4%。结论肿瘤扩大切除,应用吻合血管的腓骨、髂骨联合移植修复膝关节周围骨巨细胞瘤具有肿瘤切除相对彻底、复发率低、骨移植愈合时间短、功能恢复快,能尽量保持和重建膝关节结构和功能等优点。
Objective To study the method and effect of the vascularized fibular combined with iliac grafting after the tumor extensive resection for giant cell tumor of the bone around the knee. Methods Twenty-five patients with giant cell tumor of the bone around the knee were reviewed, who had been admitted to our hospital from October 1996 to November 2002, including 17 patients undergoing the fibular and iliac transplantation with the vessels anastomosed after the extensive excision of the bone tumor. By the surgically-staged manner of Enneking, all the patients were grouped in the stage of I A; by the Campanicci＇s radioactive image staging, 11 patients were grouped in stage Ⅰ , 5 in stage Ⅰ , and 1 in stage Ⅲ ; by the Jaffe＇s pathological staging, 9 patients were grouped in stage I , 7 in stage Ⅱ , and 1 in stage Ⅲ. Of the patients, 9 were treated by the vascularized fibular combined with iliac grafting in the proximal tibia after the tumor extensive resection, and 8 were treated by the distal femur reconstruction by the operation. The following items were also analyzed： postoperative infection, growth of the bone graft, rate of local recurrence, tumor metastasis, and bone death. The function of the knee joint was evaluated. Results According the follow-up of the 17 patients for 26 87 months （mean, 54 months）, all the bone graft healed well within 75 120 days （mean, 93 days） after operation. Two patients had a local recurrence and 3 had a mildly-narrowed joint. The flexion and extension function of the knee joint recovered, with a range of motion of the reconstructed distal femur of 80°-105° （mean, 96°） while the proximal tibia had a range of motion of 90 -120° （mean, 110°）. The functional outcome was excellent in 11 patients, good in 3 patients, fair in 1 patient, and bad in 2 patients, with a total satisfactory rate of 82.4%. Conclusion The vascularized fibular combined with iliac grafting after the tumor extensive resection to treat giant cell tumor of the bone around the knee ha
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2006年第10期981-984,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
骨巨细胞瘤
膝
骨移植
Giant cell tumor of the bone Knee Grafting of the bone
