上胫腓关节切除在胫骨近端骨肉瘤保肢中的应用

Application of the proximal fibiofibular joint resection on the limb salvage for osteosarcoma of the proximal tibia

目的探讨上胫腓关节切除在胫骨近端骨肉瘤保肢中的应用。方法 1995年8月—2004年1月11例累及上胫腓关节的胫骨近端骨肉瘤患者在新辅助化疗支持下行包括上胫腓关节的胫骨骨肿瘤整块切除、人工膝关节置换、腓肠肌瓣移位重建伸膝装置及修复软组织缺损。其中男性7例,女性4例,年龄14～23岁,平均18岁。Enneking 分期均为ⅡB期。结果 11例患者均获得随访,随访时间2～9年,平均59个月。因肺转移死亡3例,肺转移带瘤存活1例,局部复发1例行截肢术;伤口皮肤坏死1例,下肢深静脉血栓2例,腓总神经牵拉损伤2例。术后膝关节功能 MSTS 93评分55%～86%,平均为70%;膝关节活动度0°～120°,平均为85°,伸直延迟均在0°～20°。结论对累及上胫腓关节的胫骨近端骨肉瘤在新辅助化疗支持下积极行包括上胫腓关节的胫骨骨肉瘤整块切除、定制人工膝关节置换术,手术疗效满意,但应注意相关并发症的防治。

Objective To evaluate the proximal tibiofibular joint resection on the limb salvage for osteosarcoma of the proximal tibia. Methods Between August 1995 and January 2004, 11 patients with osteosarcoma of proximal tibia and tibiofibular joint involved underwent resection and endoprosthetic proximal tibial replacement. Seven patients were male and 4 were female. The patients ranged in age from 14 to 23 years （mean 18 years）. The surgical stage were ⅡB. Results The follow-up period varied from 2 to 9 years （mean 59 months ）. Three patients died of pulmonary metastases, 1 patient was still alive with pulmonary metastasis, 1 patient underwent amputation for local recurrence. There was 1 early skin necrosis, 2 transient palsy of the common peroneal nerve, and 2 thrombus of lower limb vein. The mean postoperative Musculoskeletal Tumor Society score of the knee joint was 70% （ range 55% - 86% ） , the mean postoperative range of flexition was 85° （range 0° - 120°） , and the extensor lag varied from 0° to 20°. Conclusions Limb salvage for osteosarcoma of the proximal tibia with proximal tibiofibular joint resection and custom-made prosthesis reconstruction has had excellent results, however, the prevention and treatment of relevant complications should be given more attention.