Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria.
Department of Orthopaedics and Trauma Surgery, Medical University of Vienna, Vienna, Austria.
Bone Joint J. 2021 Mar;103-B(3):553-561. doi: 10.1302/0301-620X.103B3.BJJ-2020-1308.R1.
The aims of the study were to analyze differences in surgical and oncological outcomes, as well as quality of life (QoL) and function in patients with ankle sarcomas undergoing three forms of surgical treatment, minor or major limb salvage surgery (LSS), or amputation.
A total of 69 patients with ankle sarcomas, treated between 1981 and 2017 at two tumour centres, were retrospectively reviewed (mean age at surgery: 46.3 years (SD 22.0); 31 females (45%)). Among these 69 patients 25 were analyzed prospectively (mean age at latest follow-up: 61.2 years (SD 20.7); 11 females (44%)), and assessed for mobility using the Prosthetic Limb Users Survey of Mobility (PLUS-M; for amputees only), the Toronto Extremity Salvage Score (TESS), and the University of California, Los Angeles (UCLA) Activity Score. Individual QoL was evaluated in these 25 patients using the five-level EuroQol five-dimension (EQ-5D-5L) and Fragebogen zur Lebenszufriedenheit/Questions on Life Satisfaction (FLZ).
Of the total number of patients in the study, 22 (32%) underwent minor LSS and 22 (32%) underwent major LSS; 25 underwent primary amputation (36%). Complications developed in 26 (38%) patients, and were more common in those with major or minor LSS in comparison to amputation (59% vs 36% vs 20%; p = 0.022). A time-dependent trend towards higher complication risk following any LSS was present (relative risk: 0.204; 95% confidence interval (CI) 0.026 to 1.614; p = 0.095). In the prospective cohort, mean TESS was higher following minor LSS in comparison to amputation (91.0 vs 67.3; p = 0.006), while there was no statistically significant difference between major LSS and amputation (81.6 vs 67.3; p = 0.099). There was no difference in mean UCLA (p = 0.334) between the three groups (p = 0.334). None of the items in FLZ or EQ-5D-5L were different between the three groups (all p > 0.05), except for FLZ item "self-relation", being lower in amputees.
Complications are common following LSS for ankle sarcomas. QoL is comparable between patients with LSS or amputation, despite better mobility scores for patients following minor LSS. We conclude that these results allow a decision for amputation to be made more easily in patients particularly where the principles of oncological surgery would otherwise be at risk. Cite this article: 2021;103-B(3):553-561.
本研究旨在分析接受三种手术治疗方式的踝部肉瘤患者的手术和肿瘤学结果、生活质量（QoL）和功能差异，这三种手术方式分别为小或大肢体保留手术（LSS）和截肢。
回顾性分析了 1981 年至 2017 年在两个肿瘤中心接受治疗的 69 例踝部肉瘤患者（手术时平均年龄：46.3 岁（SD 22.0）；31 名女性（45%））。其中 25 例前瞻性分析（末次随访时的平均年龄：61.2 岁（SD 20.7）；11 名女性（44%）），并使用假体使用者移动性调查（PLUS-M；仅适用于截肢者）、多伦多肢体保留评分（TESS）和加利福尼亚大学洛杉矶分校（UCLA）活动评分评估移动性。在这 25 名患者中，使用五个级别的欧洲五维健康量表（EQ-5D-5L）和生活满意度问卷（FLZ）评估个体 QoL。
研究中患者总数的 22 例（32%）接受了小 LSS，22 例（32%）接受了大 LSS；25 例接受了初次截肢（36%）。26 例（38%）患者发生了并发症，与截肢相比，大或小 LSS 患者的并发症更常见（59%比 36%比 20%；p = 0.022）。存在任何 LSS 后并发症风险呈时间依赖性增加的趋势（相对风险：0.204；95%置信区间（CI）0.026 至 1.614；p = 0.095）。在前瞻性队列中，与截肢相比，小 LSS 后的 TESS 平均值更高（91.0 比 67.3；p = 0.006），而大 LSS 与截肢之间无统计学显著差异（81.6 比 67.3；p = 0.099）。三组之间的 UCLA 平均值无差异（p = 0.334）（p = 0.334）。FLZ 或 EQ-5D-5L 中的项目之间没有差异（均 p > 0.05），除了截肢者的 FLZ 项目“自我关系”较低。
踝部肉瘤患者接受 LSS 后并发症常见。尽管接受小 LSS 的患者移动性评分更好，但 LSS 或截肢患者的 QoL 相当。我们的结论是，这些结果使我们更容易在那些否则会有肿瘤手术原则风险的患者中决定截肢。
