Zhang Chunlin, Zeng Bingfang, Zhu Kunpeng, Zhang Lei, Hu Jianping
Department of Orthopaedic Surgery, Shanghai Tenth People's Hospital Affiliated To Tongji University, 301 YanChang Zhong Road, Shanghai 200072, China.
Department of Orthopaedics, The Sixth People's Hospital Affiliated to Shanghai Jiao Tong University, 600 Yishan Road, Shanghai 200233, China.
Foot Ankle Surg. 2019 Jun;25(3):278-285. doi: 10.1016/j.fas.2017.11.006. Epub 2017 Dec 20.
The treatment of malignant tumours of the distal tibia is a challenging surgical problem due to the scarce soft tissue coverage and the instability of the ankle joint that often occurs after resection. However, there is no consensus on the ideal treatment for malignant tumours of the distal tibia.
We report a new reconstruction for five patients with high-grade osteosarcoma of distal tibia, using dual ipsilateral vascularized autogenous fibular graft in a trapezoid-shaped array and external fixator, with ankle arthrodesis and preserving subtalar joints. The patients were examined clinically and radiographically.
The average follow-up duration was 88 months. The mean wound healing time was 14 days. Bone healing was achieved for all the five patients at an average time of 7 months. There were no complications of mal-union, skin necrosis, post-operative infection, loss of internal fixation, peroneal nerve injury. One patient had a local recurrence, which required amputation 15 months postoperatively. The remaining four patients were able to walk with an average functional score of 81.25% according to MSTS.
Our study shows that this technique is safe and effective to perform implantation of dual ipsilateral vascularized autogenous fibular graft in a trapezoid-shaped array and preserving subtalar joints in terms of the distal tibial reconstruction for malignant bone tumour of the distal tibia. This reconstruction represents a biological alternative protocol for limb salvage in cases of malignant bone tumour of the distal tibia, with encouraging results and with the advantages of lower complications and accelerating recovery.
Level IV.
由于远端胫骨恶性肿瘤切除后软组织覆盖不足且常出现踝关节不稳定，其治疗是一个具有挑战性的外科问题。然而，对于远端胫骨恶性肿瘤的理想治疗方法尚无共识。
我们报告了一种针对5例远端胫骨高级别骨肉瘤患者的新重建方法，采用双侧带血管蒂自体腓骨梯形排列移植并结合外固定架，同时进行踝关节融合并保留距下关节。对患者进行了临床和影像学检查。
平均随访时间为88个月。平均伤口愈合时间为14天。5例患者均实现骨愈合，平均时间为7个月。未出现骨不连、皮肤坏死、术后感染、内固定物松动、腓总神经损伤等并发症。1例患者出现局部复发，术后15个月需行截肢术。其余4例患者能够行走，根据肌肉骨骼肿瘤学会（MSTS）评分，平均功能评分为81.25%。
我们的研究表明，对于远端胫骨恶性骨肿瘤的重建，采用双侧带血管蒂自体腓骨梯形排列移植并保留距下关节的技术是安全有效的。这种重建方法为远端胫骨恶性骨肿瘤保肢提供了一种生物学替代方案，结果令人鼓舞，具有并发症少和恢复快的优点。
四级。
