Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Clin Orthop Relat Res. 2010 Nov;468(11):3056-62. doi: 10.1007/s11999-010-1464-8.
Tumors of the fibula comprise only 2.5% of primary bone lesions. Patients with aggressive benign tumors in the proximal fibula may require en bloc resection. Peroneal nerve function, knee stability, and recurrence are substantial concerns with these resections. The incidence and fate of these complications is not well-known owing to the small numbers of patients in previous reports.
QUESTIONS/PURPOSES: We therefore analyzed the incidence of peroneal nerve palsy, knee stability, and local recurrence following surgical treatment of benign proximal fibula tumors.
We retrospectively reviewed the charts of 120 patients (121 tumors) with histologically confirmed aggressive benign tumors of the proximal fibula. There were 56 males and 64 females with an average age of 24 years (range, 2-64 years). The most common diagnosis was osteochondroma (38%) followed by giant cell tumor (19%). Pain (94%), palpable mass (39%), and peroneal nerve symptoms (12%) were the most common presenting symptoms. Of the 121 tumors, 56 (46%) underwent en bloc resection. The minimum followup was 2 years (mean, 9 years; range 2 to 49 years; median, 7.4 years).
Postoperative complications included nine peroneal nerve palsies (six transient, three permanent), one deep venous thrombosis, and one wound dehiscence. No long-term knee instability was seen with repair of the lateral collateral ligament. Ten patients had recurrences, with 70% of local recurrences occurring in patients who underwent intralesional excision.
Given the higher recurrence rate with curettage, patients with aggressive proximal fibula tumors benefit from en bloc resection. The overall morbidity is low, but postoperative permanent peroneal palsy remains a concern (3%).
腓骨肿瘤仅占原发性骨病变的 2.5%。在腓骨近端有侵袭性良性肿瘤的患者可能需要整块切除。这些切除术后存在腓总神经功能、膝关节稳定性和局部复发等重大问题。由于之前的报告中患者数量较少，这些并发症的发生率和结局并不清楚。
问题/目的：因此，我们分析了手术治疗良性腓骨近端肿瘤后腓总神经麻痹、膝关节稳定性和局部复发的发生率。
我们回顾性分析了 120 例（121 个肿瘤）经组织学证实的侵袭性良性腓骨近端肿瘤患者的病历。患者中男 56 例，女 64 例，平均年龄 24 岁（范围 2-64 岁）。最常见的诊断是骨软骨瘤（38%），其次是巨细胞瘤（19%）。最常见的症状是疼痛（94%）、可触及的肿块（39%）和腓总神经症状（12%）。在 121 个肿瘤中，56 个（46%）行整块切除。随访时间至少 2 年（平均 9 年；范围 2-49 年；中位数 7.4 年）。
术后并发症包括 9 例腓总神经麻痹（6 例为一过性，3 例为永久性）、1 例深静脉血栓形成和 1 例伤口裂开。外侧副韧带修复后未见长期膝关节不稳定。10 例患者复发，70%的局部复发发生在接受肿瘤内切除术的患者中。
鉴于刮除术的复发率较高，侵袭性腓骨近端肿瘤患者受益于整块切除。总的发病率较低，但术后永久性腓总神经麻痹仍是一个问题（3%）。
