Schubert Cornelius Dieter, Frassica Frank J, Attar Samer, Deune E Gene
Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Md.
Eplasty. 2013 Aug 19;13:e43. eCollection 2013.
To describe a novel method to reconstruct, with a vascularized rotational tibiaplasty, a complex femoral defect in an adolescent.
After a femoral osteosarcoma resection, allograft reconstruction, and chemotherapy, an 11-year-old girl developed recurrent thigh wound infections and femoral allograft osteomyelitis despite multiple operative interventions. At the age of 13, she presented to our center with a complex right thigh wound and an unstable lower extremity secondary to a segmental femoral loss. To reestablish thigh stability and function and to avoid amputation at the hip, the authors performed a rotational vascularized tibiaplasty. The tibia was rotated 180° with the pivot at the knee. The distal tibia was internally stabilized to the residual proximal femur.
Ten years later, the patient had a stable thigh, a functional hip, no evidence of infection or sarcoma, and a Toronto Extremity Salvage Score of 92.5 (minimal disability).
In this patient, the tibial rotationplasty provided a vascularized bone strut mimicking the resected femur; saved the hip; obviated an allograft bone; and created a functional, biologic, stable, and durable thigh that allowed full weight bearing on a prosthesis, with a low physical disability level. We conclude that, for patients with complex femoral defects, a vascularized rotational tibiaplasty should be considered a feasible option before amputation.
描述一种通过带血管蒂旋转胫骨成形术重建青少年复杂股骨缺损的新方法。
一名11岁女孩在接受股骨骨肉瘤切除、同种异体骨重建和化疗后，尽管进行了多次手术干预，仍出现反复的大腿伤口感染和股骨同种异体骨髓炎。13岁时，她因右大腿复杂伤口和节段性股骨缺失继发下肢不稳前来我院就诊。为重建大腿稳定性和功能并避免髋关节截肢，作者实施了带血管蒂旋转胫骨成形术。胫骨以膝关节为轴旋转180°。胫骨远端与残留的股骨近端进行内固定。
10年后，患者大腿稳定，髋关节功能良好，无感染或肉瘤迹象，多伦多肢体挽救评分为92.5（最小残疾）。
在该患者中，胫骨旋转成形术提供了一个模拟切除股骨的带血管蒂骨支柱；挽救了髋关节；避免了同种异体骨移植；并创造了一个功能良好、生物性、稳定且持久的大腿，使患者能够在假体上完全负重，身体残疾程度较低。我们得出结论，对于患有复杂股骨缺损的患者，在截肢前应考虑带血管蒂旋转胫骨成形术作为一种可行的选择。
