The Application Of Gastrocnemius Flap Repair In Endoprosthetic Replacement Of Proximal Tibia Malignant Tumors

Objective: To investigate the clinical effect of soft tissue repairation and reconstruction with gastrocnemius flap in endoprosthetic replacement of proximal tibia malignant tumors.Methods: Collect the records in total of 62 patients who had been diagnosed as proximal tibial malignant tumor in the department of orthopedics Guizhou medical university affiliated hospital during 2004 to 2012.They were divided into two groups.Group B were treated gastrocnemius flap reparation during the period of 2009 to 2012 and group A were not during the period of 2004 to 2008.These 62 cases of proximal tibial malignant tumor were consisted with 45 cases of osteosarcoma(common type),9 cases of giant cell tumor of bone(malignant),6 cases of malignant fibrous histiocytoma and 2 cases of chondrosarcoma.There were 4 cases of Enneking stage IB,18 cases of stage IIA and 27 cases of stage IIB.There was no significant difference between the two groups in age,sex and pathological type.Their clinical data of postoperative complications,recurrence rate,mortality and postoperative limb function were analyzed retrospectively.The evaluation of limb function includes two aspects: knee flexion objective measurement and subjective Enneking score.Results: There were 35 males(56.5%)and 27 females(43.5%)of these 62 patients.Their age varied form 15 to 60 years old,and 29.24±8.46 years old in average.In the incidence of postoperative complications,The patients were followed up for 24-48 months,with an average of 36.77±71 months.Postoperative complications occurred in 11 cases,B group(6.2%)was significantly better than the A group(30%).Moreover,during the follow-up period,4 of those patients had recurrence rate of 6.5%.9 of them had distant metastasis.All those 9 patients died of respiratory failure due to tumor metastasis,with the accounting of 14.5%.No significant difference was found in recurrence or mortality rate between the two groups.Ennking score at the time point of 1 year after operation of group B was 28.44±1.76,and the knee flexion objective measurement was 135.63±7.80 degrees,which were obviously better than group A(Ennking score 26.70±1.24,knee flexion objective measurement 106.33±13.6 degrees).Conclusion: Custom-made tumor knee prosthesis was an effective way for the treatment of of proximal tibia malignant tumors.Gastrocnemius flap repair in this operation played an important role both in reducing the complications and in improve artificial joint function,which was worth popularizing and applying in curing proximal tibial malignant tumor.