Sabo D, Ewerbeck V
Stiftung Orthopädische Universitätsklinik Heidelberg.
Aktuelle Traumatol. 1993 Oct;23(6):283-93.
This study correlates the clinical and radiological development of twelve patients with resection of the fibula, with the results of experimental investigations, reporting on the loss of tension-banding and proportional weight-bearing after fibula resection. Five patients underwent segmental fibula resection because of tumour disease, seven patients by reason of harvesting an intercalary allograft. Five patients suffered from lower leg pain. Spindle-shaped thickenings of the tibial cortex could be confirmed by most x-rays, in one case the tibial shaft diameter increased up to 10%. Usually the rest of the fibula will become atrophic in grown-up patients; in children the fibula may restore completely if the preparation is performed by sparing the periosteum. Three patients suffered a stress fracture of the tibia. As pain and tibial stress fracture appeared mainly if the remaining fibula was less than 1/4th of the original fibula length, the distal part should be preserved longer if justifiable from an oncological point of view. The knowledge about basic biomechanical behaviour and the arising possibility of a stress fracture or other structural changing of the tibia after fibula resection is important for correct assessment of the postoperative clinical and radiological development.
本研究将12例腓骨切除患者的临床及影像学发展情况与实验研究结果相关联，报告腓骨切除后张力带的丧失及比例负重情况。5例患者因肿瘤疾病接受节段性腓骨切除，7例患者因获取间置同种异体骨而进行切除。5例患者出现小腿疼痛。多数X线检查可证实胫骨皮质呈纺锤形增厚，1例患者胫骨干直径增加达10%。在成年患者中，通常腓骨的其余部分会萎缩；在儿童中，如果手术操作时保留骨膜，腓骨可能会完全恢复。3例患者发生胫骨应力性骨折。由于疼痛和胫骨应力性骨折主要出现在剩余腓骨长度小于原腓骨长度的1/4时，因此从肿瘤学角度合理的情况下，应更长时间地保留远端部分。了解腓骨切除后胫骨的基本生物力学行为以及发生应力性骨折或其他结构改变的可能性，对于正确评估术后临床及影像学发展情况至关重要。
