Li Xiaoya, Teng Xiao, Lin Nong, Yan Xiaobo, Li Binghao, Ye Zhaoming
Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou Zhejiang, 310009, P.R.China;Department of Orthopaedics, Taizhou Central Hospital, Taizhou Zhejiang, 318000, P.R.China.
Department of Orthopaedics, Taizhou Central Hospital, Taizhou Zhejiang, 318000, P.R.China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2020 Oct 15;34(10):1221-1225. doi: 10.7507/1002-1892.202003088.
To evaluate the effectiveness of vascularized fibula reconstruction in treatment of distal tibial malignant and invasive tumors.
Between March 2012 and January 2018, 11 patients with distal tibial malignant and invasive tumors were treated with vascularized fibula reconstruction. There were 7 males and 4 females with an average age of 20 years (range, 16-39 years). There were 8 cases of osteosarcoma, 2 cases of invasive giant cell tumor of bone, and 1 case of hemangioendothelioma. The tumors were rated as benign stage 3 in 2 cases and malignant stageⅠA in 1 case, stageⅡA in 4 cases, and stage ⅡB in 4 cases according to the Enneking staging. The disease duration was 1-6 months (mean, 2.7 months). The limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score, and the distal and proximal union of the transplanted fibula and the diameter of the fibula were examined by imaging.
All incisions healed by first intention. All patients were followed up 16-85 months (mean, 41 months). No tumor recurrence or metastasis occurred during the follow-up. The proximal and distal grafts in the 10 cases showed osseous healing, and the healing time was 7-12 months (mean, 10.1 months) at proximal end and 7-12 months (mean, 9.3 months) at distal end. In 1 case, the proximal end did not heal at 19 months, while the distal end healed at 13 months; proximal bone grafting was performed, and the proximal end healed. Among the 4 patients with distal screw fixation, 2 had peri-internal fixation fractures after graft healing, but no skin necrosis or infection occurred. All the 7 patients with distal steel plate fixation had no peri-internal fixation fracture, but 1 patient developed anterior tibial skin necrosis. At 12 months after operation, the diameter of fibula increased 1-5 mm (mean, 2.4 mm) by compared with that before operation. The MSTS score was 17-27 (mean, 22.8).
Reconstruction of ankle joint with vascularized fibula can achieve satisfactory functional results, which is one of the feasible and worthy methods for the distal tibial malignant and invasive tumors.
评估带血管腓骨重建术治疗胫骨远端恶性及侵袭性肿瘤的有效性。
2012年3月至2018年1月，11例胫骨远端恶性及侵袭性肿瘤患者接受带血管腓骨重建术治疗。其中男性7例，女性4例，平均年龄20岁（范围16 - 39岁）。骨肉瘤8例，侵袭性骨巨细胞瘤2例，血管内皮瘤1例。根据Enneking分期，2例肿瘤为良性3期，1例为恶性ⅠA期，4例为ⅡA期，4例为ⅡB期。病程1 - 6个月（平均2.7个月）。采用肌肉骨骼肿瘤学会（MSTS）评分评估肢体功能，通过影像学检查移植腓骨的远近端愈合情况及腓骨直径。
所有切口均一期愈合。所有患者随访16 - 85个月（平均41个月）。随访期间无肿瘤复发或转移。10例患者的移植腓骨远近端均实现骨性愈合，近端愈合时间为7 - 12个月（平均10.1个月），远端愈合时间为7 - 12个月（平均9.3个月）。1例患者近端在19个月时未愈合，远端在13个月时愈合；进行了近端植骨，近端最终愈合。4例采用远端螺钉固定的患者中，2例在移植骨愈合后发生内固定周围骨折，但未发生皮肤坏死或感染。7例采用远端钢板固定的患者均未发生内固定周围骨折，但1例患者出现胫前皮肤坏死。术后12个月，腓骨直径较术前增加1 - 5mm（平均2.4mm）。MSTS评分为17 - 27分（平均22.8分）。
带血管腓骨重建踝关节可获得满意的功能效果，是治疗胫骨远端恶性及侵袭性肿瘤的可行且值得推荐的方法之一。
