Hillmann A, Rosenbaum D, Gosheger G, Hoffmann C, Rödl R, Winkelmann W
Department of Orthopedics, Westfälische Wilhelms-Universität, Münster, Germany.
Clin Orthop Relat Res. 2001 Mar(384):224-31. doi: 10.1097/00003086-200103000-00026.
After resection of a malignant bone tumor of the femur, rotationplasty is considered a treatment option in addition to other limb salvage procedures such as endoprosthetic replacement, allograft, or autograft reconstruction. A Type B IIIa rotationplasty is indicated when the tumor involves the total femur or when skip lesions are detected. After the total femur is resected, the lateral tibial plateau is placed into the acetabulum after rotating the tibia and foot segment 180 degrees. Eight patients at an average age of 5.9 years underwent a rotationplasty Type B IIIa at the authors' institution. After a median followup of 59.6 months (range, 24-86 months) the clinical results were excellent and the functional status according to the criteria of the Musculoskeletal Tumor Society was good (23 of 30 points). In electromyographic analysis the muscle activity of the affected leg revealed good function of the stance and the swing phase muscles according to their new function with comparable amplitudes to the unaffected limb. The kinematics (range of motion of the hip and knee) were slightly assymmetric. Gait analysis showed a slight lateral trunk lean over the ipsilateral limb with reduced joint moment. All patients had full weightbearing ability. Remodeling of the tibial plateau into a round form mimicking a new femoral head is confirmed by radiographs and magnetic resonance imaging scans. In young children with a tumor of the total femur, rotationplasty Type B IIIa is a good treatment modality with excellent clinical and good functional results. The electromyographic and gait analysis data underscore a good functional restoration of gait after rotationplasty.
在股骨恶性骨肿瘤切除术后，除了其他保肢手术（如人工关节置换、同种异体骨移植或自体骨重建）外，旋转成形术也被视为一种治疗选择。当肿瘤累及整个股骨或发现跳跃性病变时，应采用B IIIa型旋转成形术。切除整个股骨后，将胫骨和足部段旋转180度，然后将外侧胫骨平台放入髋臼。作者所在机构对8例平均年龄5.9岁的患者进行了B IIIa型旋转成形术。中位随访59.6个月（范围24 - 86个月）后，临床结果良好，根据肌肉骨骼肿瘤学会的标准，功能状态良好（30分中的23分）。在肌电图分析中，患侧腿部的肌肉活动显示，根据其新功能，站立期和摆动期肌肉功能良好，其幅度与未受影响的肢体相当。运动学（髋关节和膝关节的活动范围）略有不对称。步态分析显示，同侧肢体上方的躯干略有向外侧倾斜，关节力矩减小。所有患者均具有完全负重能力。X线片和磁共振成像扫描证实，胫骨平台重塑成圆形，类似新的股骨头。对于患有全股骨肿瘤的幼儿，B IIIa型旋转成形术是一种良好的治疗方式，具有出色的临床效果和良好的功能结果。肌电图和步态分析数据强调了旋转成形术后步态的良好功能恢复。
