PDF(Pubmed)
Abstract：
BACKGROUND: Details of improved gait ability after wide resection of soft tissue sarcomas that necessitate removal of portions of the quadricep muscle have not yet been reported. We describe a patient with improved gait ability following a rehabilitation program after wide resection of a soft tissue sarcoma that included four components of the quadricep muscle.
METHODS: An 85-year-old Japanese man underwent wide resection of an undifferentiated pleomorphic sarcoma that included portions of the quadriceps femoris muscle. The rectus femoris, vastus medialis, sartorius, and vastus intermedius were separated in the maximally bulging region of the tumour. Three weeks postoperatively, gait exercise was initiated using a rigid knee orthosis with a dual-adjustable lock knee. The contraction loading of the knee extension muscle was controlled by adjusting the hinge motion range of the orthosis as follows: fully extended, fixed knee 0°-30°, and free range. Under this regimen, he could walk independently without a rigid orthosis within 5 weeks postoperatively but could not sit on his heels during daily living activities. At six months, there was no clinical evidence of recurrent tumours or complications.
CONCLUSIONS: Postoperative gait ability might be affected by not only the number of resected muscles but also by the function of the separated muscles and the cross-sectional area of the remaining muscle. Gradually loaded exercise of the knee extension muscles using an orthosis could result in an improved gait motion for patients who undergo wide resection of a sarcoma that includes four components of the quadriceps femoris.
METHODS: An 85-year-old Japanese man underwent wide resection of an undifferentiated pleomorphic sarcoma that included portions of the quadriceps femoris muscle. The rectus femoris, vastus medialis, sartorius, and vastus intermedius were separated in the maximally bulging region of the tumour. Three weeks postoperatively, gait exercise was initiated using a rigid knee orthosis with a dual-adjustable lock knee. The contraction loading of the knee extension muscle was controlled by adjusting the hinge motion range of the orthosis as follows: fully extended, fixed knee 0°-30°, and free range. Under this regimen, he could walk independently without a rigid orthosis within 5 weeks postoperatively but could not sit on his heels during daily living activities. At six months, there was no clinical evidence of recurrent tumours or complications.
CONCLUSIONS: Postoperative gait ability might be affected by not only the number of resected muscles but also by the function of the separated muscles and the cross-sectional area of the remaining muscle. Gradually loaded exercise of the knee extension muscles using an orthosis could result in an improved gait motion for patients who undergo wide resection of a sarcoma that includes four components of the quadriceps femoris.
摘要：
背景：软组织肉瘤广泛切除后需要切除四头肌部分的步态能力改善的细节尚未有报道。我们描述了一名患者，该患者在广泛切除包括四头肌四个组成部分的软组织肉瘤后，在康复计划后步态能力得到改善。
方法：一名85岁的日本男子接受了包括股四头肌部分的未分化多形性肉瘤的广泛切除。股直肌,中肌,Sartorius,和中间血管在肿瘤的最大隆起区域分离。术后三周,步态锻炼是使用带有双可调锁定膝盖的刚性膝盖矫形器开始的。通过调节矫形器的铰链运动范围来控制膝关节伸展肌肉的收缩负荷，如下所示：完全伸展，固定膝关节0°-30°,和自由范围。在这个方案下,他可以在术后5周内没有僵硬的矫形器独立行走，但在日常生活活动中不能坐着。六个月的时候，没有肿瘤复发或并发症的临床证据.
结论：术后步态不仅受切除肌肉数量的影响，而且受分离肌肉的功能和剩余肌肉的横截面积的影响。使用矫形器对膝盖伸展肌肉的逐渐负荷锻炼可以导致接受包括股四头肌四个部分的肉瘤的广泛切除的患者的步态运动得到改善。
方法：一名85岁的日本男子接受了包括股四头肌部分的未分化多形性肉瘤的广泛切除。股直肌,中肌,Sartorius,和中间血管在肿瘤的最大隆起区域分离。术后三周,步态锻炼是使用带有双可调锁定膝盖的刚性膝盖矫形器开始的。通过调节矫形器的铰链运动范围来控制膝关节伸展肌肉的收缩负荷，如下所示：完全伸展，固定膝关节0°-30°,和自由范围。在这个方案下,他可以在术后5周内没有僵硬的矫形器独立行走，但在日常生活活动中不能坐着。六个月的时候，没有肿瘤复发或并发症的临床证据.
结论：术后步态不仅受切除肌肉数量的影响，而且受分离肌肉的功能和剩余肌肉的横截面积的影响。使用矫形器对膝盖伸展肌肉的逐渐负荷锻炼可以导致接受包括股四头肌四个部分的肉瘤的广泛切除的患者的步态运动得到改善。
