Arikan Yavuz, Misir Abdulhamit, Gur Volkan, Kizkapan Turan Bilge, Dincel Yasar Mahsut, Akman Yunus Emre
1 Department of Orthopaedics, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey.
2 Department of Orthopaedics, Sanliurfa Training and Research Hospital, Sanliurfa, Turkey.
J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019837411. doi: 10.1177/2309499019837411.
Reconstruction of the lateral collateral ligament (LCL) and biceps femoris tendon following proximal fibula resection is controversial. Postoperative knee instability and peroneal nerve dysfunction affect outcome. This study aimed to determine functional, clinical, and radiological outcomes of patients who underwent en bloc proximal fibula resections and to compare clinical and radiological instability rates for primary repair after type I and type II resections.
Eleven patients with primary tumors of the proximal fibula were included. Musculoskeletal Tumor Society (MSTS) score and Lysholm knee score were used in the evaluation of functional outcomes. Clinical outcome was assessed using knee range of motion and knee varus stress test. Radiological outcome was assessed using varus stress knee radiographs. Knee stability was evaluated using the varus stress test at 30° of knee flexion and varus stress knee radiographs and graded in millimeters.
Of the 11 tumors, 6 (54.6%) underwent type I resection. In five (45.4%) patients, type II resection was performed. The mean follow-up period was 32 ± 13.9 months (range, 12-55 months; median, 27 months). The mean knee joint lateral opening, MSTS score, and Lysholm knee score with type I versus type II resection were 5.7 ± 1.2 mm versus 6.4 ± 1.1 mm ( p = 0.247), 28.7 ± 1.8 (95.6%) versus 20.4 ± 7.7 (68%) ( p = 0.011), and 92.2 ± 8.8 versus 62.8 ± 20.4 ( p = 0.026), respectively. Postoperative complications of all patients included one (9.1%) deep tissue infection and one (9.1%) long-term knee instability. In one patient (9.1%) who underwent type II resection, above-the-knee amputation was performed after local recurrence.
Primary repair of the LCL and biceps femoris tendon to the surrounding soft tissues after resection of proximal fibular tumors provides good clinical outcomes. Primary repair is a simple technique to perform with minimal morbidity. Peroneal nerve palsy was a problem, especially in type II resections. Level of Evidence: Therapeutic Level III.
腓骨近端切除术后外侧副韧带（LCL）和股二头肌腱的重建存在争议。术后膝关节不稳定和腓总神经功能障碍会影响治疗效果。本研究旨在确定接受整块腓骨近端切除术患者的功能、临床和影像学结果，并比较I型和II型切除术后一期修复的临床和影像学不稳定发生率。
纳入11例腓骨近端原发性肿瘤患者。采用肌肉骨骼肿瘤学会（MSTS）评分和Lysholm膝关节评分评估功能结果。通过膝关节活动范围和膝关节内翻应力试验评估临床结果。利用膝关节内翻应力X线片评估影像学结果。在膝关节屈曲30°时采用内翻应力试验和膝关节内翻应力X线片评估膝关节稳定性，并以毫米为单位进行分级。
11例肿瘤中，6例（占54.6%）接受I型切除。5例（占45.4%）患者接受II型切除。平均随访期为32±13.9个月（范围12 - 55个月；中位数27个月）。I型与II型切除相比膝关节外侧开口的平均值、MSTS评分和Lysholm膝关节评分分别为5.7±1.2mm对6.4±1.1mm（p = 0.247）、28.7±1.8（95.6%）对20.4±7.7（68%）（p = 0.011）、92.2±8.8对62.8±20.4（p = 0.026）。所有患者的术后并发症包括1例（9.1%）深部组织感染和1例（9.1%）长期膝关节不稳定。1例接受II型切除的患者在局部复发后行膝上截肢。
腓骨近端肿瘤切除术后将LCL和股二头肌腱一期修复至周围软组织可提供良好的临床效果。一期修复是一种操作简单、并发症少的技术。腓总神经麻痹是一个问题，尤其是在II型切除中。证据水平：治疗性III级。
