Harris Joshua D, Trinh Thai Q, Scharschmidt Thomas J, Mayerson Joel L
Department of Orthopaedics, Division of Musculoskeletal Oncology, The Ohio State University, Columbus, OH 43210, USA.
Orthopedics. 2013 Jan;36(1):e126-31. doi: 10.3928/01477447-20121217-32.
Rotationplasty involves wide resection of lower-extremity malignancy and approximately 180° rotation of the tibia to allow the ankle to function similarly to the former knee joint. It is most commonly used for sarcomas around the knee, such as the distal femur and proximal tibia, in adolescent and young adult patients and is an option for patients with proximal femoral focal deficiency (congenital short femur). Rotationplasty is an alternative to ablative procedures when functional outcome is a consideration or when resection of involved areas and endoprosthetic reconstruction is not possible. This article describes functional status and return to competitive sport after rotationplasty for a lower-extremity bone sarcoma with 3-year follow-up. Despite a postoperative course complicated by a distal tibial physeal injury and femoral neck stress fracture, the patient recovered fully by 1 year postoperatively. Pain free at rest and with activity and with no loss of function, the patient is a successful athlete, playing basketball and baseball and skiing competitively. The patient used a custom-made prosthesis that likely played a role in his high level of function. The patient's high function is evidenced by a maximal or near-maximal possible score on all subsections of the Short Form 36 health survey. Although this level of function is exemplary, it may be more expected in younger, more active, highly motivated, and emotionally and socially mature individuals.
旋转成形术包括广泛切除下肢恶性肿瘤，并将胫骨旋转约180°，以使踝关节发挥与原来膝关节类似的功能。它最常用于青少年和年轻成年患者膝关节周围的肉瘤，如股骨远端和胫骨近端，也是股骨近端局灶性缺损（先天性股骨短小）患者的一种选择。当考虑功能结果或无法切除受累区域并进行假体置换重建时，旋转成形术是一种替代切除手术的方法。本文描述了对一名下肢骨肉瘤患者进行旋转成形术后3年随访的功能状态和恢复竞技运动的情况。尽管术后出现了胫骨远端骨骺损伤和股骨颈应力性骨折等并发症，但患者在术后1年完全康复。患者休息和活动时均无疼痛，且功能未丧失，是一名成功的运动员，能参加篮球、棒球比赛并进行竞技滑雪。患者使用了定制假体，这可能对其高水平的功能发挥起到了作用。患者在简短健康调查问卷36项的所有子项目中都获得了最高或接近最高的分数，证明了其高功能状态。尽管这种功能水平堪称典范，但在更年轻、更活跃、积极性更高且在情感和社会方面更成熟的个体中可能更为常见。
