Soft tissue reconstruction of tumor-related proximal tibial hemiarthroplasty using synthetic mesh combined with a medial gastrocnemius flap.

IF 3.7 2区医学 Q1 ORTHOPEDICS

Journal of Orthopaedics and Traumatology Pub Date : 2025-09-26 DOI:10.1186/s10195-025-00874-7

Zhuoyu Li, Jilong Zhao, Daoyang Fan, Zhiping Deng, Yongkun Yang, Xiaohui Niu, Qing Zhang, Weifeng Liu

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Abstract

Purpose: 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.

Methods: 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).

Results: 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).

Conclusions: 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 of evidence: Level III case control study.

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合成补片联合腓肠肌内侧皮瓣重建肿瘤相关胫骨近端半关节置换术的软组织。

目的：评价人工合成补片联合腓肠肌内侧皮瓣在胫骨近端骨肉瘤切除术后行胫骨近端半关节置换术的疗效。方法：对2005年1月至2023年12月行胫骨近端半关节置换术的102例骨骼发育不成熟儿童（男58例，女44例）进行回顾性队列研究。最常见的诊断是骨肉瘤（95%）、尤文氏肉瘤（4%）和软骨肉瘤（1%）。平均年龄11岁（7 ~ 14岁），平均随访时间85个月（12 ~ 233个月）。我们根据改良的亨德森分类报告并发症。功能结果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）进行评估。结果：联合重建组患者MSTS-93和TESS评分较高（MSTS-93, 83%比72%，p = 0.023； TESS， 85%比74%，p = 0.041）。联合重建患者术后2年平均Insall-Salvati比值（ISR）、blackburn - 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。未联合重建的患者术后2年平均ISR、BPI和CDI分别为1.42±0.39、1.25±0.29和1.61±0.41 (p)。结论：人工合成补片联合腓肠肌内侧瓣进行胫骨近端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，并有望减少术后膝关节脱位和假体周围感染的发生率。证据等级：III级病例对照研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Orthopaedics and Traumatology Medicine-Orthopedics and Sports Medicine

CiteScore

4.30

自引率

0.00%

发文量

审稿时长

13 weeks

期刊介绍： The Journal of Orthopaedics and Traumatology, the official open access peer-reviewed journal of the Italian Society of Orthopaedics and Traumatology, publishes original papers reporting basic or clinical research in the field of orthopaedic and traumatologic surgery, as well as systematic reviews, brief communications, case reports and letters to the Editor. Narrative instructional reviews and commentaries to original articles may be commissioned by Editors from eminent colleagues. The Journal of Orthopaedics and Traumatology aims to be an international forum for the communication and exchange of ideas concerning the various aspects of orthopaedics and musculoskeletal trauma.