Department of Orthopedic, The First College of Clinical Medical Science, China Three Gorges University & Yichang Central People's Hospital, Yichang 443002, China.
Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, China.
Biomed Res Int. 2020 May 7;2020:6371456. doi: 10.1155/2020/6371456. eCollection 2020.
Osteochondroma is one of the most common benign bone tumor; however, the surgical treatment still remains a challenge for those that occur at the distal tibiofibular interosseous location. Previously, the transfibular approach has been successfully described, but the potential damage of the syndesmosis would give rise to the instability of the ankle joint and thus may result in the unfavorable long-term outcome. Here, a revised strategy which can protect the syndesmotic complex is introduced. From 2010 to 2017, eleven patients with the distal tibiofibular interosseous osteochondroma who underwent the revised surgery were collected. The distal fibular osteotomy and posterior tibial osteotomy were performed to keep the inferior syndesmosis intact for better stability of the ankle joint. Both the anterior tibiofibular ligaments (AITFL) and posterior tibiofibular ligaments (PITFL) have been preserved successfully, and thus, the stability of the ankle joint has been maintained due to our strategy. The VAS and AOFAS scores were utilized to assess the clinical outcome and function. Postoperatively, all the patients were pain-free and were able to wear the appropriate shoes at the last follow-up. Preoperative and postoperative AOFAS scores were 93.63 ± 6.91 and 47.27 ± 5.27 ( < 0.05), respectively. Moreover, the average VAS score was 1.73 ± 0.27 (compared with preoperative as 7.45 ± 2.15, < 0.05), demonstrating obvious improvement after the operation. To our best knowledge, this is the first time to perform the resection of the distal tibial interosseous osteochondroma involving the fibula without interrupting the inferior syndesmotic complex especially the AITFL and PITFL. We believe that this strategy may pave a new way for optimized clinical outcome for these patients with distal tibiofibular interosseous osteochondroma. This clinical trial study is registered with number ChiCTR1900024690.
骨软骨瘤是最常见的良性骨肿瘤之一；然而，对于发生在胫骨腓骨间骨间位置的骨软骨瘤，其手术治疗仍然是一个挑战。以前，已经成功描述了经腓骨入路，但联合部的潜在损伤会导致踝关节不稳定，从而可能导致不利的长期结果。这里，引入了一种可以保护联合复合体的改良策略。2010 年至 2017 年，共收集了 11 例胫骨腓骨间骨间骨软骨瘤患者行改良手术。行腓骨远端截骨和胫骨后截骨，以保持下联合完整，从而更好地维持踝关节稳定性。前胫腓骨韧带（AITFL）和后胫腓骨韧带（PITFL）均成功保留，因此，由于我们的策略，踝关节的稳定性得以维持。采用 VAS 和 AOFAS 评分评估临床结果和功能。术后所有患者均无疼痛，最后一次随访时均能穿合适的鞋子。术前和术后 AOFAS 评分分别为 93.63 ± 6.91 和 47.27 ± 5.27（<0.05）。此外，平均 VAS 评分为 1.73 ± 0.27（与术前的 7.45 ± 2.15 相比，<0.05），术后明显改善。据我们所知，这是首次在不中断下联合复合体（特别是 AITFL 和 PITFL）的情况下，对胫骨腓骨间骨间骨软骨瘤进行腓骨远端切除。我们相信，对于这些胫骨腓骨间骨间骨软骨瘤患者，该策略可能为优化临床结果开辟新途径。这项临床试验研究已在中国临床试验注册中心注册，注册号 ChiCTR1900024690。
