Hanada Masuo, Kadota H, Matsunobu T, Shimada E, Iwamoto Y
Department of Plastic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Department of Orthopedic Surgery, Kyushu University, 3-1-1, Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
Strategies Trauma Limb Reconstr. 2015 Nov;10(3):195-9. doi: 10.1007/s11751-015-0235-1. Epub 2015 Nov 17.
We present the case of an 80-year-old man with a tumor recurrence on his right arm 6 years after initial treatment. The lateral aspect of the elbow joint, involving overlaying skin, muscles, tendons, joint capsule, lateral collateral ligament complex, the lateral 1/3 of the capitellum, and lateral epicondyle of humerus were excised in the tumor resection. Intraoperative assessment revealed multidirectional instability of the elbow, and joint stabilization was needed. Because the lateral epicondyle was resected, graft placement in an anatomical position was impossible to carry out. Therefore, non-anatomical reconstruction of lateral ulnar collateral ligament with palmaris longus tendon graft was performed. The skin was reconstructed using an antegrade pedicled radial forearm flap. For wrist extension reconstruction, the pronator quadratus tendon was transferred to the extensor carpi radialis brevis tendon. One year after the operation, elbow range of motion was 5-130°. The patient remains symptom free. The Mayo elbow performance score is good. The Musculoskeletal Tumor Society rating score is excellent. To our knowledge, this is the first report of an elbow lateral ulnar collateral ligament reconstruction after tumor resection.
我们报告一例80岁男性患者，在初次治疗6年后右上肢出现肿瘤复发。肿瘤切除术中切除了肘关节外侧，包括覆盖的皮肤、肌肉、肌腱、关节囊、外侧副韧带复合体、肱骨小头外侧1/3以及肱骨外侧髁。术中评估显示肘关节存在多向不稳定，需要进行关节稳定术。由于外侧髁被切除，无法将移植物放置在解剖位置。因此，采用掌长肌腱移植物对尺侧副韧带进行非解剖重建。使用顺行带蒂桡侧前臂皮瓣重建皮肤。为重建腕关节伸展功能，将旋前方肌腱转移至桡侧腕短伸肌腱。术后1年，肘关节活动范围为5°-130°。患者无症状。梅奥肘关节功能评分良好。肌肉骨骼肿瘤学会评级分数优秀。据我们所知，这是肿瘤切除术后肘关节尺侧副韧带重建的首例报告。
