中国肿瘤临床
中國腫瘤臨床
중국종류림상
CHINESE JOURNAL OF CLINICAL ONCOLOGY
2015年
2期
109-111
,共3页
老年%复发性%软组织肉瘤%缺损%不稳定%修复%重建
老年%複髮性%軟組織肉瘤%缺損%不穩定%脩複%重建
노년%복발성%연조직육류%결손%불은정%수복%중건
elderly%recurrent%soft tissue sarcoma%defect%instability%repair%reconstruction
目的：探讨老年膝部复发性软组织肉瘤扩大切除术后膝周软组织缺损并关节不稳定的修复方法和疗效。方法：选择四川省肿瘤医院骨科2009年3月至2014年3月6例符合保肢条件和多次复发的膝周软组织肉瘤老年患者进行有效的术前化疗后，行包括内侧或外侧关节囊壁和侧副韧带在内的扩大切除术，对所形成膝周软组织缺损并关节不稳定，采用Ethibond 5号线重建侧副韧带和（或）部分关节囊壁及联合小腿复合宽蒂筋膜皮瓣或腓肠肌内侧头肌皮瓣修复软组织缺损；对术前、术后即刻及随访6个月时膝关节最大屈曲角度进行观察和统计学检验。结果：获得术中关节即刻稳定和完整覆盖软组织缺损；术前、术后即刻、术后6个月膝关节的最大屈曲角度分别为：（115.0±7.8）°、（101.7±9.3）°、（104.8±10.2）°，其中术前和术后即刻有显著性差异（t=2.68，P<0.05），术后即刻和术后6个月差异无统计学意义（t=0.55，P>0.05）。结论：简单、快速、可靠的膝关节稳定性重建和软组织缺损修复对老年膝部复发性软组织肉瘤患者是适用的。
目的：探討老年膝部複髮性軟組織肉瘤擴大切除術後膝週軟組織缺損併關節不穩定的脩複方法和療效。方法：選擇四川省腫瘤醫院骨科2009年3月至2014年3月6例符閤保肢條件和多次複髮的膝週軟組織肉瘤老年患者進行有效的術前化療後，行包括內側或外側關節囊壁和側副韌帶在內的擴大切除術，對所形成膝週軟組織缺損併關節不穩定，採用Ethibond 5號線重建側副韌帶和（或）部分關節囊壁及聯閤小腿複閤寬蒂觔膜皮瓣或腓腸肌內側頭肌皮瓣脩複軟組織缺損；對術前、術後即刻及隨訪6箇月時膝關節最大屈麯角度進行觀察和統計學檢驗。結果：穫得術中關節即刻穩定和完整覆蓋軟組織缺損；術前、術後即刻、術後6箇月膝關節的最大屈麯角度分彆為：（115.0±7.8）°、（101.7±9.3）°、（104.8±10.2）°，其中術前和術後即刻有顯著性差異（t=2.68，P<0.05），術後即刻和術後6箇月差異無統計學意義（t=0.55，P>0.05）。結論：簡單、快速、可靠的膝關節穩定性重建和軟組織缺損脩複對老年膝部複髮性軟組織肉瘤患者是適用的。
목적：탐토노년슬부복발성연조직육류확대절제술후슬주연조직결손병관절불은정적수복방법화료효。방법：선택사천성종류의원골과2009년3월지2014년3월6례부합보지조건화다차복발적슬주연조직육류노년환자진행유효적술전화료후，행포괄내측혹외측관절낭벽화측부인대재내적확대절제술，대소형성슬주연조직결손병관절불은정，채용Ethibond 5호선중건측부인대화（혹）부분관절낭벽급연합소퇴복합관체근막피판혹비장기내측두기피판수복연조직결손；대술전、술후즉각급수방6개월시슬관절최대굴곡각도진행관찰화통계학검험。결과：획득술중관절즉각은정화완정복개연조직결손；술전、술후즉각、술후6개월슬관절적최대굴곡각도분별위：（115.0±7.8）°、（101.7±9.3）°、（104.8±10.2）°，기중술전화술후즉각유현저성차이（t=2.68，P<0.05），술후즉각화술후6개월차이무통계학의의（t=0.55，P>0.05）。결론：간단、쾌속、가고적슬관절은정성중건화연조직결손수복대노년슬부복발성연조직육류환자시괄용적。
Objective: To evaluate the repair method and its curative effects on defects and joint instability in elderly patients with recurrent soft tissue sarcoma around the knee after wide excision. Methods:Our study included 6 elderly patients with limb sal-vage and effective preoperative chemotherapy. These patients underwent extended resections, including internal or lateral articular cap-sule and collateral ligament excisions. Owing to polyleptic soft-tissue sarcoma around the knee, formed soft-tissue defects, and joint in-stability, collateral ligament and/or partial articular capsule was reconstructed using #5 Ethibond sutures. Simultaneously, soft-tissue de-fects around the knee were repaired by composite-wide pedicled fasciocutaneous flaps or medial head of gastrocnemius muscle flaps of the leg. The maximum flexion angles of the knee (MFKs) were observed and statistically tested before and during surgery, with a fol-low-up period of 6 months. Results: The immediate stability of the joints and complete coverage of the soft tissue defects were achieved during the surgery. The MFKs during preoperative treatment, intraoperative treatment, and six-month follow-up were 115.0° ± 7.8°, 101.7° ± 9.3°, and 104.8° ± 10.2°, respectively, with significant differences between the preoperative and intraoperative MFKs (t=2.68, P<0.05). By contrast, no difference existed between the intraoperative and six-month follow-up MFKs (t=0.55, P>0.05). Conclu-sion:This repair method can be applied to elderly patients with polyleptic soft tissue sarcoma around the knee by using simple, fast, and reliable surgical techniques for the reconstruction, stability, and repair of soft tissue defects in the knee joint.
