整形外科と災害外科
Online ISSN : 1349-4333
Print ISSN : 0037-1033
ISSN-L : 0037-1033
坐骨神経切除を要した軟部肉腫の治療成績と機能的予後
横山 庫一郎浦田 正彦古賀 正一郎佐々木 宏介高比良 知也芳賀 敏
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1999 年 48 巻 4 号 p. 1109-1111

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A malignant tumor of the thigh sometimes needs amputation of the sciatic nerve. Well understandings of soft tissue neoplasms have made it possible to perform limb saving procedure in carefully selected cases. We performed a limb saving operation for patients involving sciatic nerve.
In an effort to determine the results of this procedure, the functions of the lower extremities were assessed in 9 patients. In 9 cases it was found by imaging studies that the sciatic nerve and vessels were located near the tumor mass. Eight patients had a local resection associated with the amputation of the sciatic nerve, and one underwent splitting of the nerve sheath. The function of the lower extremities has been assessed regularly by Enneking's evaluation system. All patients who had an amputation of the nerve had 50 to 70% function, although one exception of nerve sheath splitting gained 96%. An almost normal gait was seen in the latter patient, the other 8 patients showed major gait disturbances because of the lack of active knee flection and extension of the ankle. In contrast, patients who had amputation or disarticulation gained about 70% functional score. In this aspect the local procedure does not produce results nearly as functional as a prosthesis. Therefore, in carefully selected patients, amputation is superior to a spared limb with sciatic nerve palsy in our opinion.

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