Kanazawa Yoshimitsu, Tsuchiya Hiroyuki, Nonomura Akitaka, Takazawa Koutarou, Yamamoto Norio, Tomita Katsuro
Department of Orthopaedic Surgery, School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa 920-8641, Japan.
J Orthop Sci. 2003;8(6):757-61. doi: 10.1007/s00776-003-0714-y.
Three cases of osteosarcoma (stage IIB) of the proximal fibula were successfully treated by marginal excision that preserved the common peroneal nerve and lateral stabilizers of the knee joint. Caffeine-assisted chemotherapy was administered to three boys, ages 15, 17, and 11 years, and resulted in a complete response. Two patients initially presented with peroneal nerve palsy that resolved completely with preoperative chemotherapy. The subsequent intentional marginal procedures resulted in preservation of the common peroneal nerves, lateral collateral ligaments, and biceps femoris tendons. In two cases the collateral ligament and biceps tendon were reattached to the tibia with a spike washer or suture anchors, and in the third case they were reattached by suture only to the ligamentous and capsular structure of the tibia. All three patients have normal ankle and knee joint function without evidence of recurrence 122, 120, and 61 months after surgery, respectively. Preservation of limb function without compromising the principles of tumor surgery is a desirable goal in any patient but particularly in young patients. For patients with osteosarcoma of the proximal fibula, this approach provides a better quality of life than conventional wide excision.
3例近端腓骨骨肉瘤（IIB期）患者通过保留腓总神经和膝关节外侧稳定结构的边缘性切除获得成功治疗。对3名年龄分别为15岁、17岁和11岁的男孩进行了咖啡因辅助化疗，结果获得完全缓解。2例患者最初表现为腓总神经麻痹，术前化疗后完全缓解。随后进行的有意边缘性手术保留了腓总神经、外侧副韧带和股二头肌肌腱。2例患者的副韧带和二头肌肌腱用尖齿垫圈或缝线锚钉重新附着于胫骨，第3例仅通过缝线重新附着于胫骨的韧带和关节囊结构。3例患者术后分别在122、120和61个月时踝关节和膝关节功能正常，无复发迹象。在不影响肿瘤手术原则的前提下保留肢体功能是所有患者尤其是年轻患者的理想目标。对于近端腓骨骨肉瘤患者，这种方法比传统的广泛切除能提供更好的生活质量。
