带血管蒂腓骨重建治疗胫骨远端肿瘤的疗效研究  

Treatment of distal tibial tumor with vascularized fibula reconstruction

作　　者：李小亚 滕晓[2] 林秾[1] 严晓波[1] 李冰皓[1] 叶招明[1] 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)

机构地区：[1]浙江大学医学院附属第二医院骨科,杭州310009 [2]台州市中心医院骨科,浙江台州318000

出　　处：《中国修复重建外科杂志》2020年第10期1221-1225,共5页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨采用带血管蒂腓骨重建治疗胫骨远端恶性及侵袭性肿瘤的疗效。方法2012年3月—2018年1月,采用带血管蒂腓骨重建治疗11例胫骨远端恶性及侵袭性肿瘤患者。其中男7例,女4例;年龄16~39岁,平均20岁。原发性骨肉瘤8例,侵袭性骨巨细胞瘤2例,血管内皮瘤1例。Enneking分期:良性3期2例,恶性ⅠA期1例、ⅡA期4例、ⅡB期4例。病程1~6个月,平均2.7个月。术后采用美国骨与软组织肿瘤协会(MSTS)评分评价患肢功能;影像学复查移植腓骨远、近端愈合情况,测量腓骨直径。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间16~85个月,平均41个月。随访期间均无肿瘤复发及转移发生。10例移植腓骨近、远端均达骨性愈合,其中近端愈合时间7~12个月,平均10.1个月;远端愈合时间7~12个月,平均9.3个月。1例移植腓骨远端术后13个月时愈合;近端19个月时仍未愈合,行近端植骨术后愈合。4例远端螺钉固定者中,2例移植腓骨愈合后发生内固定周围骨折,无1例发生皮肤坏死及感染;7例远端钢板固定者均未出现移植腓骨内固定周围骨折,但1例发生胫前皮肤坏死。术后12个月时,腓骨直径较术前增加1~5 mm,平均2.4 mm。MSTS评分为17~27分,平均22.8分。结论对于胫骨远端恶性及侵袭性肿瘤,采用带血管蒂腓骨重建可获得较好踝关节功能,是一种有效的保肢手术。Objective To evaluate the effectiveness of vascularized fibula reconstruction in treatment of distal tibial malignant and invasive tumors.Methods 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 stageⅡB 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.Results 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 periinternal 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).Conclusion Reconstruction of ankle joint with vascularized fibula can achieve satisfactory functional results,which is one of the feasible and worthy methods for the distal tib

关 键 词：胫骨远端肿瘤 带血管蒂腓骨 踝关节 关节融合术 

分 类 号：R738.1[医药卫生—肿瘤]