Chhajed Bipinkumar B, Mehta Milind A, Prajapati Ashwin
Department of Orthopedics, Vyas Medical College, Jodhpur, Rajasthan India.
Dr. Jivraj Mehta Smarak Health Foundation, Bakeri Medical Research Centre, Dr Jivraj Mehta Marg Paldi, Ahmedabad, Gujarat India.
Indian J Orthop. 2024 Jun 16;58(9):1310-1315. doi: 10.1007/s43465-024-01190-8. eCollection 2024 Sep.
Amongst primary patella tumor Campanacci grade 3 tumor of Giant cell tumor of bone (GCTB) and malignant tumors requires patellectomy. We had a patient with huge recurrent GCTB of patella with involvement of skin. We reconstructed extensor mechanism of Knee with long iliotibial band (ITB) tendon graft.
After patellectomy, we harvested long ITB graft (length 22 cm; width proximally 6 cm, distally 1.5 cm) through patellectomy wound and small "L" shaped incision proximally. We passed ITB graft from patella tendon and quadriceps tendon in figure of 8 manner and sutured it back to itself and host tendon with fiber Wire and closed both the wounds primarily. We started ROM and quadriceps strengthening in graded manner. We measured functional outcome with Musculoskeletal Tumour Society (MSTS) scoring system.
There were no post-operative complications. At 10 weeks follow up, patient had no extension lag and knee ROM was 90°. At final follow up of 7 months patient regained pre-operative functional status without knee instability. Her MSTS score was 30 and she was disease free.
Reconstruction of extensor mechanism of knee with ITB graft doesn't have donor site morbidity and gives excellent function with graded physiotherapy protocol.
在原发性髌骨肿瘤中，骨巨细胞瘤（GCTB）的坎帕纳奇3级肿瘤和恶性肿瘤需要进行髌骨切除术。我们有一位患有巨大复发性髌骨GCTB且累及皮肤的患者。我们用长髂胫束（ITB）肌腱移植重建了膝关节的伸肌机制。
髌骨切除术后，我们通过髌骨切除伤口和近端的小“L”形切口获取长ITB移植物（长度22厘米；近端宽度6厘米，远端宽度1.5厘米）。我们将ITB移植物以8字形从髌腱和股四头肌腱穿过，并用纤维线将其自身与宿主肌腱缝合，然后一期缝合两个伤口。我们开始逐步进行关节活动度（ROM）和股四头肌强化训练。我们用肌肉骨骼肿瘤学会（MSTS）评分系统测量功能结果。
术后无并发症。在10周随访时，患者无伸膝滞后，膝关节ROM为90°。在7个月的最终随访中，患者恢复了术前功能状态，膝关节无不稳定。她的MSTS评分为30分，且无疾病复发。
用ITB移植物重建膝关节伸肌机制无供区并发症，通过分级物理治疗方案可获得优异功能。
