Prajapati Ashwin, Gulia Ashish, Hegde Prateek, Puri Ajay
Dept of Surgical Oncology, Tata Memorial Hospital, HBNI, Mumbai, India.
J Clin Orthop Trauma. 2020 May-Jun;11(3):467-470. doi: 10.1016/j.jcot.2020.03.023. Epub 2020 Apr 9.
Reconstruction modalities described after distal fibula resection varies from no reconstruction to size matched allograft or reconstruction with ipsilateral proximal fibula. Every procedure has their own limitation. We used Prolene mesh to reconstruct lateral restraint (Meshplasty) after distal fibulectomy.
Is a minimal reconstruction using prolene mesh (meshplasty) adequate to restore ankle stability and function post distal fibula resection?
This retrospective analysis was performed in patients who underwent distal fibulectomy at the tertiary cancer hospital in India, between 01/01/2006 and 31/12/2016. Distal fibulectomy was performed through standard lateral approach. A prolene mesh was anchored to distal tibia and talus using screws or Ethibond sutures. Rehabilitation protocol included below knee cast for 6 weeks followed by gradual full weight bearing mobilization and ankle range of motion. Total 9 patients with mean age of 25 years (range: 13-43) got operated for distal fibulectomy during this period. Mean resection length was 13.3 cm (range: 9-20).
Seven patients were available for final assessment at a median follow-up duration of 78 months (range: 34-161 months). Two patients developed local recurrence. Two patients developed distant recurrence both died of disease. One patient of GCT developed local recurrence in soft tissue at 30months, which was excised. Another patient of OGS developed local recurrence after 8 months along with distant recurrence. One patient of PNET developed distant recurrence at 3 months. One patient had a valgus deformity at 55 months follow up without any restriction of activity while the others had a stable ankle without any deformity. The mean MSTS score was 28 (24-29).
"Meshplasty" after distal fibulectomy is an easy, reproducible, time and cost effective reconstruction modality with minimal complications. It adequately restores ankle function while providing results comparable to other procedures.
IV.
腓骨远端切除术后所描述的重建方式各不相同，从无重建到尺寸匹配的同种异体移植或同侧近端腓骨重建。每种手术都有其自身的局限性。我们使用普理灵网片在腓骨远端切除术后重建外侧稳定结构（网片成形术）。
使用普理灵网片进行的最小化重建（网片成形术）是否足以恢复腓骨远端切除术后的踝关节稳定性和功能？
对2006年1月1日至2016年12月31日期间在印度一家三级癌症医院接受腓骨远端切除术的患者进行了这项回顾性分析。通过标准外侧入路进行腓骨远端切除术。使用螺钉或Ethibond缝线将普理灵网片固定于胫骨远端和距骨。康复方案包括膝关节以下石膏固定6周，随后逐渐完全负重活动及踝关节活动度训练。在此期间，共有9例平均年龄25岁（范围：13 - 43岁）的患者接受了腓骨远端切除术。平均切除长度为13.3厘米（范围：9 - 20厘米）。
7例患者可供最终评估，中位随访时间为78个月（范围：34 - 161个月）。2例患者出现局部复发。2例患者出现远处复发，均死于疾病。1例骨巨细胞瘤患者在30个月时软组织出现局部复发，予以切除。另1例骨外骨肉瘤患者在8个月时出现局部复发并伴有远处复发。1例原始神经外胚层肿瘤患者在3个月时出现远处复发。1例患者在随访55个月时出现外翻畸形，但活动无受限，其他患者踝关节稳定无畸形。平均肌肉骨骼肿瘤协会（MSTS）评分为28分（24 - 29分）。
腓骨远端切除术后的“网片成形术”是一种简单、可重复、省时且经济有效的重建方式，并发症最少。它能充分恢复踝关节功能，同时提供与其他手术相当的效果。
四级
