Musculoskeletal Tumor Center, Beijing Key Laboratory for Musculoskeletal Tumors, Peking University People's Hospital, Beijing, China.
Bone Joint J. 2018 Dec;100-B(12):1633-1639. doi: 10.1302/0301-620X.100B12.BJJ-2018-0779.R1.
We retrospectively report our experience of managing 30 patients with a primary malignant tumour of the distal tibia; 25 were treated by limb salvage surgery and five by amputation. We compared the clinical outcomes of following the use of different methods of reconstruction.
There were 19 male and 11 female patients. The mean age of the patients was 19 years (6 to 59) and the mean follow-up was 5.1 years (1.25 to 12.58). Massive allograft was used in 11 patients, and autograft was used in 14 patients. The time to union, the survival time of the reconstruction, complication rate, and functional outcomes following the different surgical techniques were compared. The overall patient survival was also recorded.
Out of 14 patients treated with an autograft, 12 (86%) achieved union at both the proximal and distal junctions. The time to union at both junctions of the autograft was significantly shorter than in those treated with an allograft (11.1 vs 17.2 months, p = 0.02; 9.5 vs 16.2 months, p = 0.04). The complication rate of allograft reconstruction was 55%. The five patients treated with an amputation did not have a complication. Out of the 25 patients who were treated with limb salvage, three (12%) developed local recurrence and underwent amputation. The mean functional Musculoskeletal Tumor Society (MSTS) score after autograft reconstruction was higher than after allograft reconstruction (81% vs 67%; p = 0.06), and similar to that after amputation (81% vs 82%; p = 0.82). The two- and five-year overall rates of survival were 83% and 70%, respectively.
This consecutive case series supports the safety of limb salvage and the effectiveness of biological reconstruction after the resection of a primary tumour of the distal tibia. Autograft might be a preferable option. In some circumstances, below-knee amputation remains a valid option.
我们回顾性报告了治疗 30 例胫骨远端原发性恶性肿瘤患者的经验；25 例行保肢手术，5 例行截肢术。我们比较了使用不同重建方法的临床结果。
19 例男性，11 例女性。患者平均年龄为 19 岁（6 至 59 岁），平均随访 5.1 年（1.25 至 12.58 年）。11 例患者采用大块同种异体骨移植，14 例患者采用自体骨移植。比较了不同手术技术的愈合时间、重建物的存活率、并发症发生率和功能结果。还记录了总的患者存活率。
14 例自体骨移植患者中，12 例（86%）在近、远两端均达到愈合。自体骨移植的愈合时间在近端和远端都明显短于同种异体骨移植（11.1 与 17.2 个月，p = 0.02；9.5 与 16.2 个月，p = 0.04）。同种异体骨重建的并发症发生率为 55%。5 例行截肢术的患者均无并发症。25 例保肢治疗的患者中有 3 例（12%）发生局部复发而行截肢术。自体骨移植重建后的平均肌肉骨骼肿瘤学会（MSTS）功能评分高于同种异体骨移植（81%比 67%；p = 0.06），与截肢术相似（81%比 82%；p = 0.82）。两年和五年的总生存率分别为 83%和 70%。
本连续病例系列研究支持胫骨远端原发性肿瘤切除后保肢治疗的安全性和生物重建的有效性。自体骨可能是一种更优的选择。在某些情况下，膝下截肢仍然是一种有效的选择。
