Melendez M, Brandt K, Evans G R
Department of Plastic Surgery, The University of Texas, MD Anderson Cancer Center, Houston, USA.
Ann Plast Surg. 2001 Apr;46(4):375-81. doi: 10.1097/00000637-200104000-00004.
Limb salvage for extremity sarcoma has become the standard of care when possible. This review attempts to determine the outcome of sciatic nerve reconstruction after surgical tumor resection. The authors' objective was to determine the clinical value of extremity salvage with such a defect. Five patients (two male, three female) were selected from a department database at The University of Texas M.D. Anderson Cancer Center between 1995 and 1999 who met the following criteria: lower limb tumor resection involving a gap in the sciatic nerve with subsequent nerve autograft reconstruction. An additional patient who underwent primary sciatic nerve neurorrhaphy was also included. The average tumor size was 203 cm2. The most common tumor histology was spindle cell sarcoma. The average autograft length was 13 +/- 3.2 cm with one to four cables employed. Currently, 3 patients are still alive. Four of the 5 patients who received sciatic autonerve grafts reported partial distal sensory recovery subjectively. The patient who underwent primary neurorrhaphy has both motor and sensory innervation 42 months after surgery. Although not ideal for all patients, sciatic nerve reconstruction is a viable option for those willing to undergo limb preservation. Notable limitations to daily activity do not appear to be present, and patients are able to ambulate with or without assistive devices. With aggressive rehabilitation, some patients are able to function quite well with this bioprosthesis. Patients should consider, however, that their extremity is on loan. Substantial wound complications or infections may ultimately lead to amputation.
对于肢体肉瘤，尽可能进行保肢已成为标准治疗方案。本综述旨在确定手术切除肿瘤后坐骨神经重建的效果。作者的目的是确定存在此类缺损时保肢的临床价值。从德克萨斯大学MD安德森癌症中心1995年至1999年的科室数据库中选取了5例患者（2例男性，3例女性），这些患者符合以下标准：下肢肿瘤切除，坐骨神经出现缺损，随后进行神经自体移植重建。还纳入了1例接受原发性坐骨神经缝合术的患者。肿瘤平均大小为203平方厘米。最常见的肿瘤组织学类型是梭形细胞肉瘤。自体移植平均长度为13±3.2厘米，使用1至4股移植神经束。目前，3例患者仍存活。5例接受坐骨神经自体移植的患者中有4例主观报告远端感觉部分恢复。接受原发性神经缝合术的患者术后42个月运动和感觉功能均恢复。虽然并非对所有患者都理想，但对于愿意接受保肢的患者来说，坐骨神经重建是一种可行的选择。日常活动似乎没有明显限制，患者能够借助或不借助辅助器械行走。通过积极的康复治疗，一些患者使用这种生物假体能够很好地发挥功能。然而，患者应该考虑到他们的肢体是暂时保留的。严重的伤口并发症或感染最终可能导致截肢。
