Pilge H, Holzapfel B M, Rechl H, Prodinger P M, Lampe R, Saur U, Eisenhart-Rothe R, Gollwitzer H
Heinrich-Heine-University, Moorenstr.5, 40225 Düsseldorf, Germany.
Queensland, University of Technology, 60 Musk Avenue, Kelvin Grove, QLD 4049, Brisbane, Australia.
Bone Joint J. 2015 Aug;97-B(8):1063-9. doi: 10.1302/0301-620X.97B8.35440.
The aim of this study was to analyse the gait pattern, muscle force and functional outcome of patients who had undergone replacement of the proximal tibia for tumour and alloplastic reconstruction of the extensor mechanism using the patellar-loop technique. Between February 1998 and December 2009, we carried out wide local excision of a primary sarcoma of the proximal tibia, proximal tibial replacement and reconstruction of the extensor mechanism using the patellar-loop technique in 18 patients. Of these, nine were available for evaluation after a mean of 11.6 years (0.5 to 21.6). The strength of the knee extensors was measured using an Isobex machine and gait analysis was undertaken in our gait assessment laboratory. Functional outcome was assessed using the American Knee Society (AKS) and Musculoskeletal Tumor Society (MSTS) scores. The gait pattern of the patients differed in ground contact time, flexion heel strike, maximal flexion loading response and total sagittal plane excursion. The mean maximum active flexion was 91° (30° to 110°). The overall mean extensor lag was 1° (0° to 5°). The mean extensor muscle strength was 25.8% (8.3% to 90.3%) of that in the non-operated leg (p < 0.001). The mean functional scores were 68.7% (43.4% to 83.3%) (MSTS) and 71.1 (30 to 90) (AKS functional score). In summary, the results show that reconstruction of the extensor mechanism using this technique gives good biomechanical and functional results. The patients' gait pattern is close to normal, except for a somewhat stiff knee gait pattern. The strength of the extensor mechanism is reduced, but sufficient for walking.
本研究的目的是分析采用髌环技术进行胫骨近端肿瘤置换及伸肌机制异体重建患者的步态模式、肌肉力量和功能结果。1998年2月至2009年12月期间，我们对18例胫骨近端原发性肉瘤患者进行了广泛局部切除、胫骨近端置换及采用髌环技术的伸肌机制重建。其中9例患者在平均11.6年（0.5至21.6年）后可供评估。使用Isobex机器测量膝关节伸肌力量，并在我们的步态评估实验室进行步态分析。使用美国膝关节协会（AKS）和肌肉骨骼肿瘤学会（MSTS）评分评估功能结果。患者的步态模式在地面接触时间、足跟触地屈曲、最大屈曲负荷反应和矢状面总偏移方面存在差异。平均最大主动屈曲为91°（30°至110°）。总体平均伸肌滞后为1°（0°至5°）。伸肌平均力量为健侧的25.8%（8.3%至90.3%）（p<0.001）。平均功能评分为68.7%（43.4%至83.3%）（MSTS）和71.1（30至90）（AKS功能评分）。总之，结果表明采用该技术重建伸肌机制可获得良好的生物力学和功能结果。除了膝关节步态稍显僵硬外，患者的步态模式接近正常。伸肌机制力量降低，但足以满足行走需求。
