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目的探讨胫骨单髁骨巨细胞瘤行肿瘤切除,应用自体髂骨移植、单髁置换重建膝关节功能的临床应用,提出手术步骤及方法,观察其疗效。方法 2008年7月至2012年6月,我院收治胫骨近端单髁骨巨细胞瘤患者6例,男4例,女2例;内侧髁3例,外侧髁3例,年龄22~45岁,平均38岁,均为初次发病,病史3~10个月。按照CT横截面,肿瘤破坏最大横轴线≤1/2,关节软骨面明显受侵,2例有周围软组织受侵,3例有病理骨折;采用肿瘤整块切除,行自体髂骨移植、单髁表面置换术重建膝关节功能。结果经6个月至4年随访,肿瘤无复发,根据国际保肢学会功能评分标准,术后依疼痛程度、功能活动、心理接受程度、是否需用外部支持、行走能力及步态6个指标来评价效果。本组优5例,良1例。患膝关节活动范围均在0°~120°之间,关节稳定性好,效果满意。结论胫骨单髁骨巨细胞瘤,行肿瘤骨单髁切除、自体骨移植加单髁表面置换术,重建膝关节功能,经中短期观察疗效满意,膝关节功能恢复良好。
Objective To investigate the clinical application of autologous iliac bone graft and unicondylar replacement in the resection of giant cell tumors of the tibial condyles and the reconstruction of knee joint function. The surgical procedures and methods were put forward to observe the curative effect. Methods From July 2008 to June 2012, 6 cases of proximal unilateral condylar giant cell tumor of the tibia were treated in our hospital. There were 4 males and 2 females, including 3 medial condyles and 3 lateral condyles, ranging in age from 22 to 45 years , An average of 38 years old, are the first incidence, history of 3 to 10 months. According to the CT cross-section, the largest transverse axis of tumor destruction was ≤1 / 2, the surface of articular cartilage was obviously invaded, the surrounding soft tissue was invaded in 2 cases and the pathological fracture in 3 cases. Tumor resection was performed with autologous iliac bone graft. Surface replacement to reconstruct knee function. Results After 6 months to 4 years of follow-up, there was no recurrence of tumor. According to the international standards for functional safety of limb salvage, postoperative pain level, functional activity, psychological acceptability, external support, walking ability and gait 6 indexes To evaluate the effect. This group excellent in 5 cases, good in 1 case. Patients suffering from knee joint range of motion are between 0 ° ~ 120 °, good joint stability, satisfactory results. CONCLUSION: The unilateral giant cell tumor of the tibia is treated with unilateral condylar excision and autologous bone grafting combined with unicondylar surface replacement to reconstruct the function of knee joint. The curative effect is satisfactory after short-term observation and the knee joint function recovered well.