Li Zhuoyu, Zhao Jilong, Fan Daoyang, Deng Zhiping, Yang Yongkun, Niu Xiaohui, Zhang Qing, Liu Weifeng
Department of Orthopaedic Oncology Surgery, Peking University Fourth School of Clinical Medicine, Beijing, 100035, China.
Department of Orthopaedic Oncology Surgery, National Center for Orthopedics, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
J Orthop Traumatol. 2025 Sep 26;26(1):58. doi: 10.1186/s10195-025-00874-7.
This study was to evaluate the efficacy of soft tissue reconstruction using synthetic mesh and a medial gastrocnemius flap in patients who underwent proximal tibial hemiarthroplasty after resection of proximal tibial bone sarcomas.
A retrospective cohort study was conducted on 102 skeletally immature children (58 males, 44 females) who underwent proximal tibial Hemiarthroplasty between January 2005 and December 2023. The most common diagnoses were osteosarcoma (95%), Ewing's sarcoma (4%), and chondrosarcoma (1%). The mean age was 11 years (7-14 years) and the mean follow-up was 85 months (12-233 months). We reported complications according to the modified Henderson classification. The functional outcomes were evaluated by Musculoskeletal Tumour Society Score (MSTS-93) and the Toronto Extremity Salvage Score (TESS).
Patients in the combined reconstruction group had higher MSTS-93 and TESS scores (MSTS-93, 83% versus 72%, p = 0.023; TESS, 85% versus 74%, p = 0.041). The mean 2-year postoperative Insall-Salvati ratio (ISR), the Blackburne-Peel index (BPI), and the Caton-Deschamps index (CDI) for patients who underwent combined reconstruction were 1.18 ± 0.32, 0.98 ± 0.22, and 1.21 ± 0.28, respectively. While, The mean 2-year postoperative ISR, BPI, and CDI of patients without combined reconstruction were 1.42 ± 0.39, 1.25 ± 0.29, and 1.61 ± 0.41, respectively (p < 0.05). The combined reconstruction group had a lower mean extensor lag (4.3° versus 11.3°, p < 0.001). In total, 33 patients had at least one complication and 27 patients underwent surgical revision, including 13 infections, 8 local recurrences, 3 soft tissue failures, 2 aseptic loosening, and 1 implant failure. The combined reconstruction group had a lower rate of knee dislocation (2.7% versus 21.4%, p = 0.002).
Soft tissue reconstruction of the proximal tibia using synthetic mesh combined with a medial gastrocnemius flap improves the postoperative efficacy of tumor-related proximal hemiarthroplasty and is expected to reduce the incidence of postoperative knee dislocation and periprosthetic infection.
Level III case control study.
本研究旨在评估在胫骨近端骨肉瘤切除术后接受胫骨近端半关节置换术的患者中，使用合成网片和腓肠肌内侧头肌瓣进行软组织重建的疗效。
对2005年1月至2023年12月期间接受胫骨近端半关节置换术的102例骨骼未成熟儿童（58例男性，44例女性）进行回顾性队列研究。最常见的诊断为骨肉瘤（95%）、尤因肉瘤（4%）和软骨肉瘤（1%）。平均年龄为11岁（7 - 14岁），平均随访时间为85个月（12 - 233个月）。我们根据改良的亨德森分类法报告并发症。通过肌肉骨骼肿瘤学会评分（MSTS - 93）和多伦多肢体挽救评分（TESS）评估功能结局。
联合重建组患者的MSTS - 93和TESS评分更高（MSTS - 93，83%对72%，p = 0.023；TESS，85%对74%，p = 0.041）。接受联合重建的患者术后2年的平均Insall - Salvati比率（ISR）、Blackburne - Peel指数（BPI）和Caton - Deschamps指数（CDI）分别为1.18±0.32、0.98±0.22和1.21±0.28。而未进行联合重建的患者术后2年的平均ISR、BPI和CDI分别为1.42±0.39、1.25±0.29和1.61±0.41（p < 0.05）。联合重建组的平均伸膝滞后角度更低（4.3°对11.3°，p < 0.001）。共有33例患者至少发生1种并发症，27例患者接受了手术翻修，包括13例感染、8例局部复发、3例软组织失败、2例无菌性松动和1例植入物失败。联合重建组的膝关节脱位发生率更低（2.7%对21.4%，p = 0.002）。
使用合成网片联合腓肠肌内侧头肌瓣对胫骨近端进行软组织重建可提高肿瘤相关近端半关节置换术的术后疗效，并有望降低术后膝关节脱位和假体周围感染的发生率。
III级病例对照研究。
