腓骨近端骨软骨瘤切除前后腓总神经功能。
Peroneal Nerve Function Before and Following Surgical Excision of a Proximal Fibular Osteochondroma.
机构信息
Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA.
Division of Paediatric Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
出版信息
J Pediatr Orthop. 2021 Jan;41(1):61-66. doi: 10.1097/BPO.0000000000001688.
BACKGROUND
Osteochondromas occur most commonly in the distal femur, proximal tibia, and humerus. There are no large studies reviewing the outcome of treatment for patients with an osteochondroma involving the proximal fibula. The purpose of this study is to specifically understand the manifestations of a proximal fibular osteochondroma (PFO) on the preoperative peroneal nerve function, and how surgical management of the osteochondroma affects function immediately postoperatively and at long-term follow-up.
METHODS
This is an institutional review board-approved retrospective review of a consecutive series of patients with a PFO treated operatively at a single institution. The medical record was carefully reviewed to identify demographic data, clinical data especially the status of the peroneal function at various time points.
RESULTS
There were 25 patients with 31 affected extremities who underwent surgical excision of the PFO at an average age of 12.4 years (range, 3.0 to 17.9 y). There were 16 males and 9 females. The underlying diagnosis was isolated PFO in 2 (8%) patients and multiple hereditary exostosis in 23 (92%) patients. Preoperatively, 9 (29%) had a foot drop and 22 (71%) did not. Those with a preoperative foot drop underwent surgery at a younger age (9.1 vs. 13.8 y) (P<0.004) and postoperatively 5 (55.5%) had complete resolution, 3 (33.3%) had improvement, and 1 (11.1%) persisted requiring an ankle foot orthosis. Of the 22 who were normal preoperatively, 5 (22.7%) developed an immediate postoperative foot drop, 3 (60%) completely resolved, 1 (20%) improved, and 1 (20%) persisted and was found to have a transected nerve at exploration. In total, 23 of the 25 (92%) patients who had a PFO excision, had a normal or near-normal peroneal nerve function including those who had poor function preoperatively.
CONCLUSIONS
Patients with a PFO have a preoperative peroneal nerve dysfunction 30% of the time and 23% of those who were normal preoperatively have postoperative dysfunction. Fortunately, nearly all patients have a complete recovery following excision of the osteochondroma.
LEVEL OF EVIDENCE
Level IV.
背景
骨软骨瘤最常发生于股骨远端、胫骨近端和肱骨。目前尚无大型研究回顾分析累及腓骨近端的骨软骨瘤患者的治疗结果。本研究的目的是专门了解腓骨近端骨软骨瘤（PFO）对术前腓总神经功能的影响，以及骨软骨瘤的手术处理如何在术后即刻和长期随访中影响功能。
方法
这是一项在一家机构进行的经机构审查委员会批准的回顾性连续病例系列研究，研究对象为在单一机构接受手术切除 PFO 的患者。仔细审查病历以确定人口统计学数据和临床数据，特别是各时间点腓总神经功能的状态。
结果
25 例患者的 31 侧肢体接受了 PFO 手术切除，平均年龄为 12.4 岁（范围为 3.0 至 17.9 岁）。男性 16 例，女性 9 例。2 例（8%）患者的基础诊断为孤立性 PFO，23 例（92%）患者为多发性遗传性外生骨疣。术前，9 例（29%）有足下垂，22 例（71%）无足下垂。术前有足下垂的患者手术年龄更小（9.1 岁比 13.8 岁）（P<0.004），术后 5 例（55.5%）完全缓解，3 例（33.3%）改善，1 例（11.1%）持续存在需要佩戴踝足矫形器。术前正常的 22 例患者中，术后即刻出现足下垂 5 例（22.7%），完全缓解 3 例（60%），改善 1 例（20%），持续存在 1 例（20%），经探查发现神经切断。25 例接受 PFO 切除术的患者中，23 例（92%）的腓总神经功能正常或接近正常，包括术前功能不佳的患者。
结论
PFO 患者术前腓总神经功能障碍发生率为 30%，术前正常的患者中有 23%术后出现功能障碍。幸运的是，几乎所有患者在切除骨软骨瘤后都能完全恢复。
证据等级
IV 级。
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