Musculoskeletal Tumor Center, Peking University People's Hospital, No.11 Xizhimen South Street, Xicheng District, Beijing, 100044, China.
BMC Musculoskelet Disord. 2019 Aug 9;20(1):367. doi: 10.1186/s12891-019-2742-6.
Reconstruction for large bone defect of distal tibia after wide resection of tumor is difficult, and the best option remains controversial. This study presents a novel "double-strut" fibula ankle arthrodesis for this issue.
Nine patients with malignant or aggressive tumors of distal tibia underwent novel "double-strut" fibula ankle arthrodesis after wide tumor resection were retrospectively reviewed. We assessed the bone union time, complications and oncology outcome clinically and radiographically. The Musculoskeletal Tumor Society (MSTS) score and the Foot and Ankle Outcome Score (FAOS) were used to evaluate the functional outcome.
The average followup period was 53 ± 46 months. There was no deep infection or graft fracture observed in this series. Internal fixation loosening was found in one case. In these patients, eight achieved union at both proximal and distal junctions, while one achieved union only distally. The mean union time of the proximal junctions and distal junctions was 10.5 ± 1.6 months and 8.7 ± 2.3 months, respectively. The mean postoperative MSTS score was 83% ± 8%. The subscales of FAOS indicating the most problem was Sport and Recreation Function with a mean score of 18 ± 11. At the final follow-up, one of them (1/9, 11%) experienced local recurrence in soft tissue and received another resection surgery, and four (4/9, 44%) patients developed lung metastases.
For large bone defect of distal tibia, this novel "double-strut" fibula reconstruction can be a viable alternative, which is capable of achieving durable ankle fusion and functional salvaged limb with low rate of complications.
广泛切除肿瘤后胫骨远端大骨缺损的重建较为困难，最佳选择仍存在争议。本研究提出了一种新型的“双支柱”腓骨踝关节融合术来解决这个问题。
回顾性分析 9 例胫骨远端恶性或侵袭性肿瘤患者，在广泛肿瘤切除后采用新型“双支柱”腓骨踝关节融合术。我们从临床和影像学方面评估了骨愈合时间、并发症和肿瘤学结果。采用肌肉骨骼肿瘤学会（MSTS）评分和足踝结局评分（FAOS）评估功能结果。
平均随访时间为 53±46 个月。本系列中未观察到深部感染或移植物骨折。1 例发现内固定松动。在这些患者中，8 例近、远端均达到愈合，1 例仅远端愈合。近端和远端的平均愈合时间分别为 10.5±1.6 个月和 8.7±2.3 个月。术后平均 MSTS 评分为 83%±8%。FAOS 各子量表中，运动和娱乐功能得分最低，平均为 18±11。末次随访时，其中 1 例（1/9，11%）软组织局部复发，再次接受切除手术，4 例（4/9，44%）患者发生肺转移。
对于胫骨远端大骨缺损，新型“双支柱”腓骨重建术是一种可行的选择，可实现持久的踝关节融合和功能保留肢体，并发症发生率低。
