Xu Leilei, Zhou Jin, Wang Zhou, Xiong Jin, Qiu Yong, Wang Shoufeng
Department of Orthopedic Surgery, The Affiliated Drum Tower Hospital of Nanjing University Medical School, China.
Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, China.
Foot Ankle Surg. 2018 Apr;24(2):149-153. doi: 10.1016/j.fas.2017.01.006. Epub 2017 Feb 4.
To investigate the effectiveness of tibiotalocalcaneal arthrodesis with a retrograde nail and allograft in limb salvage surgery for patients with distal tibia osteosarcoma.
5 patients diagnosed as distal tibia osteosarcoma underwent ankle arthrodesis with a retrograde nail in our hospital. During the follow-up, radiographic views of the ankle joint were taken in two planes to assess bone healing and axis alignment. Other measurements of outcomes included procedure-related complications, local recurrence, and metastasis. Functional outcomes were evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system.
Postoperative complications occurred in 4 patients, including 4 cases of mild subcutaneous fluid and 1 case of screw breakage. All patients showed stable ankle and could stand or walk with the assistance of crutch before the complete union between allograft and host bone. One patient died due to multiple bone and pulmonary metastasis at 1 year after surgery. As for the other 4 patients, they were followed-up regularly for a mean period of 42 months. No local recurrence or distant metastasis occurred in any of these four patients. All the 4 patients expressed satisfaction with the outcome. According to MSTS scale, the mean postoperative functional score was 74.3%±4.4% (range, 70%-81%).
Intramedullary retrograde nail for distal tibia osteosarcoma could produce a satisfactory outcome in terms of functional results and complications. Excellent stabilization of the ankle joint can be achieved through this technique, as it allows patients to perform much earlier postoperative weight-bearing exercise.
探讨逆行髓内钉联合同种异体骨在胫骨远端骨肉瘤保肢手术中进行胫距跟关节融合的有效性。
5例被诊断为胫骨远端骨肉瘤的患者在我院接受了逆行髓内钉踝关节融合术。随访期间，在两个平面拍摄踝关节X线片以评估骨愈合和轴线对齐情况。其他结果测量包括与手术相关的并发症、局部复发和转移。功能结果采用肌肉骨骼肿瘤学会（MSTS）评分系统进行评估。
4例患者出现术后并发症，包括4例轻度皮下积液和1例螺钉断裂。所有患者在同种异体骨与宿主骨完全愈合前，踝关节均保持稳定，可借助拐杖站立或行走。1例患者术后1年因多发骨转移和肺转移死亡。另外4例患者平均随访42个月，这4例患者均未出现局部复发或远处转移，所有4例患者对结果均表示满意。根据MSTS评分，术后平均功能评分为74.3%±4.4%（范围为70%-81%）。
对于胫骨远端骨肉瘤，逆行髓内钉在功能结果和并发症方面可产生令人满意的效果。通过该技术可实现踝关节的良好稳定，因为它允许患者更早地进行术后负重锻炼。
