Sciatic Nerve Reconstruction: Limb Preservation After Sarcoma Resection
Sciatic Nerve Reconstruction: Limb Preservation After Sarcoma Resection
复制标题
坐骨神经重建：肉瘤切除后的肢体保留
DOI：
10.1097/00000637-200104000-00004
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发表时间：
2001
影响因子：
1.5
通讯作者：
G. Evans
中科院分区：
文献类型：
--
作者：
Marta Melendez;K. Brandt;G. Evans
在可能的情况下，肢体肉瘤的保肢已成为标准治疗方法。本文综述了坐骨神经肿瘤切除后重建的结果。作者的目的是确定这种缺陷的肢体挽救的临床价值。从德克萨斯大学医学博士的部门数据库中选择了五名患者（两名男性，三名女性）。安德森癌症中心在1995年和1999年之间，谁符合以下标准：下肢肿瘤切除涉及的差距，在坐骨神经与随后的神经自体移植重建。还包括另一名接受初次坐骨神经缝合术的患者。平均肿瘤大小为203 cm 2。最常见的肿瘤组织学是梭形细胞肉瘤。平均自体移植物长度为13 ± 3.2 cm，使用1 - 4根电缆。目前，3名患者仍然活着。接受坐骨神经自体移植的5例患者中有4例主观报告远端感觉部分恢复。接受初次神经缝合术的患者在手术后42个月具有运动和感觉神经支配。虽然不是所有患者的理想选择，但坐骨神经重建对于那些愿意接受肢体保留的患者来说是一个可行的选择。对日常活动的显著限制似乎不存在，患者能够在有或没有辅助设备的情况下走动。通过积极的康复，一些患者能够使用这种生物瓣膜发挥良好的功能。然而，患者应该考虑到他们的肢体是借来的。严重的伤口并发症或感染可能最终导致截肢。
Limb salvage for extremity sarcoma has become the standard of care when possible. This review attempts to determine the outcome of sciatic nerve reconstruction after surgical tumor resection. The authors’ objective was to determine the clinical value of extremity salvage with such a defect. Five patients (two male, three female) were selected from a department database at The University of Texas M.D. Anderson Cancer Center between 1995 and 1999 who met the following criteria: lower limb tumor resection involving a gap in the sciatic nerve with subsequent nerve autograft reconstruction. An additional patient who underwent primary sciatic nerve neurorrhaphy was also included. The average tumor size was 203 cm2. The most common tumor histology was spindle cell sarcoma. The average autograft length was 13 ± 3.2 cm with one to four cables employed. Currently, 3 patients are still alive. Four of the 5 patients who received sciatic autonerve grafts reported partial distal sensory recovery subjectively. The patient who underwent primary neurorrhaphy has both motor and sensory innervation 42 months after surgery. Although not ideal for all patients, sciatic nerve reconstruction is a viable option for those willing to undergo limb preservation. Notable limitations to daily activity do not appear to be present, and patients are able to ambulate with or without assistive devices. With aggressive rehabilitation, some patients are able to function quite well with this bioprosthesis. Patients should consider, however, that their extremity is on loan. Substantial wound complications or infections may ultimately lead to amputation.