Hillmann A, Gosheger G, Hoffmann C, Ozaki T, Winkelmann W
Department of Orthopedics, Westfälische Wilhelms-Universität, Münster, Germany.
Arch Orthop Trauma Surg. 2000;120(10):555-8. doi: 10.1007/s004020000175.
Twelve patients aged between 10.9 and 64.7 (mean 28.5) years with a malignant tumour of the knee region underwent a rotationplasty after failed primary limb salvage procedure. The reasons for failure which finally lead to surgery were recurrent infection in 10 patients and local recurrence of the tumour in 2. The number of operations before the rotationplasty was performed was between 2 and 23 (mean 6.7). According to the primary tumour site, 9 patients underwent a rotationplasty type A1, 3 patients type A2, and 1 patient type BII. In 9 patients the rotationplasty was successful, but 3 patients finally had to undergo amputation. Intraoperative preservation of the vessels was difficult in these 3 patients due to infection and oedema of the arteries or massive fibrous tissues after the previous surgery. After rotationplasty, 3 of 9 patients had to undergo additional surgery because of thrombosis, pseudarthrosis and infection (n = 5, range 1-2). The mean follow-up after rotationplasty was 34.9 (range 13-65) months. The mean functional status according to the MSTS criteria in patients after rotationplasty scored 21.3 of 30 points. In the group of amputees, the score was 19 (range 16-22). Concerning the health-related quality-of-life, the mean score in physical functioning was 76.3 in the group with a rotationplasty versus 50.0 in the group of amputees. Patients with a rotationplasty reached a higher score of global health status (77.1 vs 58.3). Based on the present results we are convinced that rotationplasty can be recommended as a treatment option after a failed limb salvage procedure.
12例年龄在10.9至64.7岁（平均28.5岁）之间的膝部区域恶性肿瘤患者，在初次保肢手术失败后接受了旋转成形术。导致最终手术的失败原因包括10例患者反复感染，2例患者肿瘤局部复发。在进行旋转成形术之前的手术次数在2至23次之间（平均6.7次）。根据原发肿瘤部位，9例患者接受了A1型旋转成形术，3例患者接受了A2型旋转成形术，1例患者接受了BII型旋转成形术。9例患者的旋转成形术成功，但3例患者最终不得不接受截肢。由于动脉感染和水肿或先前手术后大量纤维组织，这3例患者术中血管保留困难。旋转成形术后，9例患者中有3例因血栓形成、假关节和感染（n = 5，范围1 - 2）而不得不接受额外手术。旋转成形术后的平均随访时间为34.9个月（范围13 - 65个月）。根据MSTS标准，旋转成形术后患者的平均功能状态评分为30分中的21.3分。在截肢组中，评分为19分（范围16 - 22分）。关于与健康相关的生活质量，旋转成形术组的身体功能平均评分为76.3分，而截肢组为50.0分。接受旋转成形术的患者在整体健康状况方面得分更高（77.1对58.3）。基于目前的结果，我们确信旋转成形术可作为保肢手术失败后的一种治疗选择被推荐。
