Department of Orthopedic Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
Department of Orthopedic Surgery, Christian Medical College, Vellore, Tamil Nadu, India.
Knee. 2021 Mar;29:332-344. doi: 10.1016/j.knee.2021.02.014. Epub 2021 Mar 6.
Extensor mechanism function after a proximal tibial tumour excision is the major determining factor for the limb function. However, problems of extensor lag, delayed healing and poor functional outcomes exist with the previous methods of its reconstruction. We describe a novel technique of using a patellar stainless steel (SS) wire to reconstruct the extensor apparatus of the knee in non-porous coated implants and examine the functional outcome and associated complications.
This was a retrospective analytical interventional study. Twenty-six patients operated between 2011 and 2019 were included. Extensor lag measured at 6 months and 12 months postoperative, total range of motion at 12 months and Musculoskeletal Tumor Society (MSTS) score at the final visit were retrieved. Complications that occurred during the follow up period were noted. Patellar position was measured using comparative patellar-position-ratio.
Mean extensor lag at 6 months was 18.5° which improved to 8.7° at 12 months. Patellar malposition and deep infection were found to be the causes of poor functional outcome. A patellar-position-ratio between 0.9 and 1.1 led to a well-functioning extensor apparatus. Four patients underwent above-knee amputations. Deep infection and amputations reduced the MSTS score. An SS wire give way after 6 months did not affect the extensor power. A medial gastrocnemius flap reduced the infection rates.
Patellar SS wiring is an effective technique for reconstructing the knee extensor apparatus following a proximal tibial tumour excision mega-prosthesis. Proper position of the SS wire prevents wire-related complications. For a well-functioning extensor apparatus, use of a gastrocnemius flap cover intra-operatively is pertinent along with lack of infection for a pain-free, stable and mobile limb.
胫骨近端肿瘤切除后伸肌功能是决定肢体功能的主要因素。然而，以前重建伸肌的方法存在伸肌滞后、愈合延迟和功能结果不佳的问题。我们描述了一种使用髌骨不锈钢（SS）线重建非多孔涂层植入物中膝关节伸肌装置的新技术，并检查了其功能结果和相关并发症。
这是一项回顾性分析性干预研究。纳入了 2011 年至 2019 年期间接受手术的 26 名患者。术后 6 个月和 12 个月测量伸肌滞后，12 个月时测量总活动范围，最终就诊时测量肌肉骨骼肿瘤学会（MSTS）评分。记录随访期间发生的并发症。使用比较髌骨位置比测量髌骨位置。
术后 6 个月时平均伸肌滞后为 18.5°，12 个月时改善至 8.7°。髌骨位置不当和深部感染被认为是功能结果不佳的原因。髌骨位置比在 0.9 到 1.1 之间导致伸肌装置功能良好。4 名患者接受了膝上截肢。深部感染和截肢降低了 MSTS 评分。术后 6 个月 SS 线失效并未影响伸肌力量。使用腓肠肌内侧瓣降低了感染率。
髌骨 SS 线是重建胫骨近端肿瘤切除后大假体膝关节伸肌装置的有效技术。正确的 SS 线位置可防止与线相关的并发症。为了获得功能良好的伸肌装置，术中使用腓肠肌内侧瓣覆盖以及避免感染对于无痛、稳定和活动的肢体至关重要。
