摘要
目的回顾性分析累及腓骨的胫骨近端恶性肿瘤患者病历资料，探讨其保肢技术，总结肿瘤学结果、并发症及功能情况。方法自1998年11月至2010年2月，共有32例胫骨近端恶性肿瘤累及腓骨的患者接受保肢治疗，男21例，女11例；年龄10-66岁，平均23．4岁。骨肉瘤23例，软骨肉瘤5例，恶性骨巨细胞瘤1例，软组织肉瘤3例。全部病例接受包括腓骨上段在内的肿瘤整块切除，术中结扎并切断胫前血管14例，修补胫后血管1例，结扎并切断胫前血管并修补胫后血管2例、置换3例。切除腓总神经4例，腓深神经5例。采用关节假体置换24例，瘤段骨灭活再植假体复合置换5例，瘤段骨灭活再植3例。软组织覆盖采用腓肠肌内侧头肌瓣转移14例、外侧头肌瓣转移1例。结果随访时间11-159个月，平均39．4个月。6例（18．8％）患者出现肿瘤局部复发。患者总体5年生存率51．2％，14例死于肿瘤转移、2例带瘤生存、16例无瘤生存。15例（46．9％）发生各种并发症22例次，术后血管危象致患肢缺血4例，腓总神经麻痹12例，伤口表浅感染或积液4例，深部感染1例，假体周围骨折1例。国际骨肿瘤协会（Musculoskeletal Tumor Society，MSTS93）评分平均21．6分（72％）。结论胫骨近端恶性肿瘤累及上胫腓关节或腓骨时，应严格掌握适应证、仔细操作，以期获得足够的外科边界。尽管有一定的并发症发生，但是多数患者可以获得较好的术后功能。
Objective To investigate technique, effect, complications of limb salvage surgery for malignant tumors of the proximal tibia involving the fibula. Methods Between November 1998 and February 2010, 32 patients with malignant tumors of the proximal tibia involving the fibula underwent limb salvage surgery in our institute. There were 21 males and 11 females, aged from 10 to 66 years （average, 23.4 years）. There were 23 cases of osteosarcoma, 5 cases of choncdrosarcoma, 1 case of malignant giant cell tumor, and 3 cases of soft tissue sarcoma. All patients received en bloc resection of tumor including proximal tibia and fibula. During operations, ligation of anterior tibial vessels was performed in 14 patients, anastomo- sis of posterior tibial vessels in 1 patient, both ligation of anterior tibial vessels and anastomosis or replacement of posterior tibial vessels in 5 patients. The common peroneal nerve was resected in 4 patients, and the deep peroneal nerve was resected in 5 patients. The reconstruction methods included prosthetic replacement in 24 patients, replacement with inactivated autograft-prosthesis composite in 5 patients, and replacement with inactivated autograft in 3 patients. The caput mediale musculi gastrocnemii flap was transferred to re- construct soft tissue defect in 14 patients, while caput laterale musculi gastrocnemii flap was transferred in 1 patient. Results All patients were followed up for 11 to 159 months （average, 39.4 months）. Local recurrence occurred in 6 patients （18.8%）. The overall 5-year survival rate was 51.2%. Fourteen patients died of tumor metastasis, 2 survived with tumor, and 16 patients survived without tumor. Variant complications occurred in 15 patients （46.9%）. The complications included ischemia of the lower leg in 4 patients, peroneal nerve palsy in 12 patients （permanent palsy in 9 patients and temporary palsy in 3 patients）, wound healing problem in 4 patients, deep infection in 1 patient, and periprosthetic fracture in 1 patient. The mean MSTS 93
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2012年第11期1055-1059,共5页
Chinese Journal of Orthopaedics
关键词
胫骨
腓骨
骨肿瘤
四肢
挽救疗法
Tibia
Fibula
Bone neoplasms
Extremities
Salvage therapy
