恶性腓骨近端肿瘤：112 例的手术治疗。

Malignant proximal fibular tumors: surgical management of 112 cases.

机构信息

Department of Orthopedic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.

出版信息

J Bone Joint Surg Am. 2012 Nov 21;94(22):e165. doi: 10.2106/JBJS.K.00953.

DOI:10.2106/JBJS.K.00953

PMID:23172332

Abstract

BACKGROUND

Malignant tumors of the proximal part of the fibula are rare. We sought to analyze the presenting characteristics, postoperative complications, and local recurrences of malignant tumors in the proximal part of the fibula in a large series of patients.

METHODS

We identified 112 histologically confirmed malignant tumors of the proximal part of the fibula from the time period between 1910 and 2007. The sex ratio was nearly equal (fifty-four male, fifty-eight female). The average age of the patients was 27.6 years, and the average follow-up period was 5.7 years.

RESULTS

Osteosarcoma (44%) was the most common diagnosis. Pain (86%), palpable mass (51%), and peroneal nerve symptoms (12%) were the most common presenting symptoms. One hundred and three (92%) of 112 underwent curative surgical treatment. The two most common procedures were amputation in fifty (45%) of 112 patients and Malawer type-II resection in twenty-four (21%) of 112 patients. Deliberative sacrifice of the peroneal nerve was performed in seventy-four patients (66%). Postoperative complications occurred in fourteen (12.5%) of 112 patients, including wound issues (ten of 112), peroneal nerve palsy despite nerve preservation (two of twenty-nine), and posterior tibial artery thrombosis (two of 112). No long-term knee instability was seen in the fifty-three patients who underwent resection with lateral collateral ligament reconstruction. Fifty-six patients (50%) developed distant metastases and twelve (11%) had local recurrences.

CONCLUSIONS

Osteosarcomas are the most common malignant tumor of the proximal fibula. Complication rates are modest and long-term knee instability was not seen in patients undergoing reconstruction of the lateral collateral ligament. Local recurrence following resection is not uncommon and metastatic dissemination is the main cause of death. This series represents the largest collection of such tumors for which there is extended follow-up and data on surgical complications.

摘要

背景

腓骨近端的恶性肿瘤较为罕见。我们旨在通过大样本分析来明确此类肿瘤的临床表现、术后并发症和局部复发的情况。

方法

回顾性分析 1910 年至 2007 年间的 112 例腓骨近端恶性肿瘤患者的临床资料，其中男 54 例，女 58 例，男女比例接近 1:1。患者平均年龄 27.6 岁，平均随访时间 5.7 年。

结果

最常见的诊断为骨肉瘤（44%）。最常见的临床表现为疼痛（86%）、可触及的肿块（51%）和腓总神经症状（12%）。112 例患者中 103 例行根治性手术治疗，其中 50 例行截肢术（45%），24 例行 MalawerⅡ型切除术（21%）。74 例行腓总神经预防性切断术（66%）。术后并发症发生率为 12.5%（14 例），包括伤口问题（112 例中的 10 例）、腓总神经麻痹（29 例中有 2 例）和胫后动脉血栓形成（112 例中有 2 例）。行侧副韧带重建的 53 例患者中，无长期膝关节不稳定。56 例患者（50%）发生远处转移，12 例（11%）发生局部复发。