腓骨近端恶性肿瘤的手术分型及膝踝关节功能评价的临床研究  

Clinical study on the operative classification of proximal fibula malignant tumors and functional evaluation of knee and ankle joint

作　　者：高原 邱恩铎[2] 夏铁男 王玉名[2] 严贤科 胡伟 杨超 唐本森 邱冰 商冠宁[2] GAO Yuan;QIU Enduo;XIA Tienan;WANG Yuming;YAN Xianke;HU Wei;YANG Chao;TANG Bensen;QIU Bing;SHANG Guanning(Department of Orthopedic,Guizhou Province Orthopedic Hospital,Guiyang 550007,China;Department of Bone and Soft Tissue Tumour Surgery,Liaoning Cancer Hospital and Institute,Shenyang 110004,China)

机构地区：[1]贵州省骨科医院骨科,贵州贵阳550007 [2]辽宁省肿瘤医院骨与软组织肿瘤科,辽宁沈阳110042

出　　处：《中国肿瘤外科杂志》2021年第2期141-145,共5页Chinese Journal of Surgical Oncology

基　　金：国家癌症中心攀登基金项目(NCC201806B012);辽宁省肿瘤医院--大连理工大学“医工交叉研究基金”项目(LD202004)。

摘　　要：目的回顾性分析外科手术治疗腓骨近端侵袭性及恶性骨肿瘤的临床疗效,探索腓骨近端侵袭性及恶性骨肿瘤切除方式,及手术方式对膝踝关节功能和稳定性的评价。方法自2014年7月至2019年8月辽宁省肿瘤医院收治腓骨近端肿瘤患者15例。依据肿瘤性质及侵袭程度决定外科手术切除方式,根据术前及术中保留或切除腓总神经、关节内或关节外切除上胫腓关节设计手术分型,即腓深神经-上胫腓关节分型(DPN-PTFJ分型)。手术分为4型,Ⅰ型:保留腓深神经、关节内切除上胫腓关节;Ⅱ型:切除腓深神经、关节内切除上胫腓关节;Ⅲ型:保留腓深神经、关节外切除上胫腓关节;Ⅳ型:切除腓深神经、关节外切除上胫腓关节。结果该研究中15例腓骨近端肿瘤手术均获成功,其中采用Ⅰ型、Ⅲ型的患者,术后踝关节功能良好;Ⅱ型、Ⅳ型术后出现足下垂;Ⅰ型、Ⅱ型术后膝关节稳定性较好;Ⅲ型、Ⅳ型出现不同程度的膝关节失稳状态。结论依据DPN-PTFJ分型,可以较好地实施外科手术计划及术后功能评价,为依据区域解剖学施行个体化的腓骨近端侵袭性及恶性骨肿瘤规范化治疗提供了有益探索。Objective To explore the clinical efficiency of surgical treatment on malignant primary bone tumors with invasiveness in the proximal fibularetrospectively,and its influenceon the function and stability of the knee and ankle joint.Methods From July 2014 to August 2019,15 patients with proximal fibular tumors were admitted to Liaoning Cancer Hospital.Surgical resection was determined according to the tumortype,which was consisted of four types including TypeⅠ:retaining the deep peronealnerve with intra-articular resection of upper tibiofibular joint;TypeⅡ:resecting the deep peroneal nerve within tra-articular resection of upper tibiofibular joint;TypeⅢ:retaining of the deep peroneal nerve withextra-articular resection ofupper tibiofibular joint;TypeⅣ:resecting of the deep peroneal nerve with extra-articular resection of the upper tibi of ibular joint.Results All cases with proximal fibula tumor were successfully operated.The patients treated with TypeⅠand TypeⅢoperation had proper ankle function.However,foot dropoccurred in the patients who underwent TypeⅡand TypeⅣoperation.The patients received TypeⅠand TypeⅡoperation had better postoperative knee stability.TypeⅢand TypeⅣextra-articular resection of the upper tibiofibular joint with resection of the lateral structures of the knee appeared different levels of structure instability of the knee joint.Conclusions Surgical plan and postoperative function evaluation can be implemented through the deep peroneal nerve and upper tibiofibular joint classification,which provides beneficial exploration for individualized standardized treatment of aggressive and malignant primary bone tumors in the proximal fibula based on regional anatomy.

关 键 词：腓骨近端 手术分型 腓骨肿瘤 膝关节稳定性 踝关节稳定性 

分 类 号：R73[医药卫生—肿瘤]