Grimer R J, Carter S R, Tillman R M, Sneath R S, Walker P S, Unwin P S, Shewell P C
Royal Orthopaedic Hospital, Northfield, Birmingham, UK.
J Bone Joint Surg Br. 1999 May;81(3):488-94. doi: 10.1302/0301-620x.81b3.9234.
We have performed endoprosthetic replacement after resection of tumours of the proximal tibia on 151 patients over a period of 20 years. During this period limb-salvage surgery was achieved in 88% of patients with tumours of the proximal tibia. Both the implant and the operative technique have been gradually modified in order to reduce complications. An initial rate of infection of 36% has been reduced to 12% by the use of a flap of the medial gastrocnemius, to which the divided patellar tendon is attached. Loosening and breakage of the implant have been further causes of failure. We found that the probability of further surgical procedures being required was 70% at ten years and the risk of amputation, 25%. The development of a new rotating hinge endoprosthesis may lower the incidence of mechanical problems. Limb salvage for tumours of the proximal tibia is fraught with complications, but the good functional outcome in successful cases justifies its continued use.
在20年的时间里，我们对151例胫骨近端肿瘤切除术后的患者进行了人工关节置换。在此期间，88%的胫骨近端肿瘤患者实现了保肢手术。为了减少并发症，植入物和手术技术都在逐步改进。通过使用附着有髌腱的内侧腓肠肌瓣，初始感染率从36%降至了12%。植入物的松动和断裂是另外的失败原因。我们发现，10年后需要进一步手术的概率为70%，截肢风险为25%。新型旋转铰链式人工关节的研发可能会降低机械问题的发生率。胫骨近端肿瘤的保肢手术充满并发症，但成功病例良好的功能结果证明继续采用该方法是合理的。
