El-Sherbiny Magdy
The Department of Surgery, National Cancer Institute, Cairo University.
J Egypt Natl Canc Inst. 2008 Jun;20(2):187-95.
The aim of this study was to evaluate the long term behavior of pedicled vascualrized fibula graft in reconstruction of middle and distal tibia defects following malignant tumor resection with particular emphasis on success in limb salvage and the specific late related complications.
Between 1997 and 2006, 16 patients having malignant bone tumors of the middle tibia (10 cases) and distal tibia (6 cases) were candidate for wide resection of their tumors and reconstruction of the bony defect by ipsilateral vascularized pedicled fibular graft based on the peroneal vessels. There were 9 males and 7 females with a mean age of 13 years at time of surgery (range 11-23 years). Mean follow up period was 52 months (range 32 -110 months). Fixation was done by cast in 14 cases and by plate and screws in 2 patients. According to the Enneking staging system (1), 9 patients had stage IIB and 7 had stage IIA. Bony union and hypertrophy were assessed radio graphically on regular basis. Hypertrophy was estimated in a percentage. Functional limb results were also reported according to MSTS functional scores [2].
The mean length of bony gap bridged was 14 cm (range of 11.0-16.0 cm) and the mean length of fibula harvested was 15.5 cm (range 12-17 cm). Ninety seven percent of patients (15 cases) healed primarily at a mean time of 4.8 months (range 3.5-6 months). Hypertrophy was evident in all patients and ranged from 60 to 210% (mean 91% ). Increase in size of the hypertrophied fibula beyond the recipient bone was noticed in three cases (18.7% ) and we relate this to weight-bearing forces and not to the size of the recipient bone. The mean time of the fibula to double its size (10 cases) was 21 months (range 18-31 months). Young patients developed full hypertrophy earlier than older patients. Complication rate was low. One patient had non union at the proximal end of the fibulotibial junction and two patients had stress fracture of the fibula.
Long term follow-up of pedicled vascularized fibula in reconstruction of bony defects of the middle or distal tibia after bone tumor resection showed that it is a useful tool in the limb salvage procedure. It is a short procedure, inexpensive, with low rate of late complications. It has a good outcome regarding the union, hypertrophy and the functional outcome.
本研究旨在评估带蒂血管化腓骨移植在恶性肿瘤切除术后重建胫骨干中、远端骨缺损中的长期表现，特别强调保肢成功率及特定的晚期相关并发症。
1997年至2006年间，16例患有胫骨干中部（10例）和远端（6例）恶性骨肿瘤的患者，拟行肿瘤广泛切除，并采用基于腓血管的同侧带蒂血管化腓骨移植重建骨缺损。其中男性9例，女性7例，手术时平均年龄13岁（范围11 - 23岁）。平均随访时间为52个月（范围32 - 110个月）。14例采用石膏固定，2例采用钢板螺钉固定。根据Enneking分期系统（1），9例为IIB期，7例为IIA期。定期通过X线评估骨愈合及肥大情况。肥大以百分比估算。还根据MSTS功能评分[2]报告肢体功能结果。
平均桥接骨缺损长度为14 cm（范围11.0 - 16.0 cm），平均切取腓骨长度为15.5 cm（范围12 - 17 cm）。97%的患者（15例）一期愈合，平均愈合时间为4.8个月（范围3.5 - 6个月）。所有患者均有明显肥大，范围为60%至210%（平均91%）。3例（18.7%）患者肥大的腓骨超出受区骨，我们认为这与负重力量有关，而非受区骨大小。10例腓骨增粗一倍的平均时间为21个月（范围18 - 31个月）。年轻患者比年长患者更早出现完全肥大。并发症发生率低。1例患者腓胫关节近端骨不连，2例患者腓骨应力性骨折。
对带蒂血管化腓骨重建胫骨干中、远端骨肿瘤切除术后骨缺损进行长期随访显示，它是保肢手术中的一种有用工具。该手术操作简单、费用低廉，晚期并发症发生率低。在骨愈合、肥大及功能结果方面均有良好表现。
