Angelini Andrea, Bohacek Ivan, Plecko Mihovil, Biz Carlo, Trovarelli Giulia, Cerchiaro Mariachiara, Di Rubbo Giuseppe, Ruggieri Pietro
Department of Orthopedics and Traumatology and Oncological Orthopedics, University of Padova, Italy.
Department of Orthopaedic Surgery, University Hospital Centre Zagreb, School of Medicine, University of Zagreb, Salata, Zagreb, Croatia.
EFORT Open Rev. 2024 Jun 3;9(6):503-516. doi: 10.1530/EOR-23-0159.
Primary bone tumors of the fibula are rare. Distal fibular resection has a significant impact on ankle biomechanics and gait, possibly leading to complications such as ankle instability, valgus deformity, and degenerative changes. Question: Is there a need for reconstructive surgery after distal fibular resection, and what reconstructive procedures are available?
The review is registered with the PROSPERO International Register of Systematic Reviews. Inclusion criteria consisted of all levels of evidence, human studies, patients of all ages and genders, publication in English, and resection of the distal portion of the fibula due to tumor pathology. The reviewers defined four different categories of interest by method of treatment. Additional articles of interest during full-text review were also added.
The initial search resulted with a total of 2958 records. After screening, a total of 50 articles were included in the study. Articles were divided into 'No reconstruction', 'Soft tissue reconstruction', 'Bone and soft tissue reconstruction', and 'Arthrodesis, arthroplasty or other reconstruction options' groups.
Limb salvage surgery should be followed by reconstruction in order to avoid complications. Soft tissue reconstructions should always be considered to stabilize the joint after fibular resection. Bone reconstruction with reversed vascularized fibula is the preferred technique in young patients and in cases of bone defects more than 3 cm, while arthrodesis should be considered in adult patients. Whenever possible for oncologic reason, if a residual peroneal malleolus could be preserved, we prefer augmentation with a sliding ipsilateral fibular graft.
腓骨原发性骨肿瘤较为罕见。腓骨远端切除对踝关节生物力学和步态有重大影响，可能导致诸如踝关节不稳、外翻畸形和退行性改变等并发症。问题：腓骨远端切除术后是否需要进行重建手术，有哪些可用的重建手术方法？
本综述已在国际系统评价前瞻性注册库（PROSPERO）注册。纳入标准包括所有证据级别、人体研究、所有年龄和性别的患者、英文发表的文章，以及因肿瘤病理而切除腓骨远端部分。 reviewers根据治疗方法定义了四个不同的关注类别。全文评审期间感兴趣的其他文章也被纳入。
初步检索共获得2958条记录。筛选后，共有50篇文章纳入本研究。文章分为“不重建”、“软组织重建”、“骨与软组织重建”以及“关节融合术、关节成形术或其他重建选择”组。
保肢手术后应进行重建以避免并发症。腓骨切除术后应始终考虑进行软组织重建以稳定关节。对于年轻患者以及骨缺损超过3cm的情况，带血管蒂腓骨倒转重建是首选技术，而对于成年患者应考虑关节融合术。只要出于肿瘤学原因有可能保留残留的腓骨外踝，我们更倾向于使用同侧滑动腓骨移植进行增强。
