腓骨近端肿瘤切除术后膝关节稳定性重建的临床研究

RECONSTRUCTION OF THE KNEE STABILITY AFTER RESECTION OF TUMORS OF THE PROXIMAL FIBULA

目的探讨腓骨近端肿瘤切除术后重建膝关节稳定性的方法及临床疗效。方法回顾分析2008年1月-2009年12月行近端腓骨切除并重建腓侧副韧带和股二头肌肌腱骨性止点的16例腓骨近端肿瘤患者(试验组)临床资料,与同期5例未行韧带骨性重建患者(对照组)进行比较。两组患者性别、年龄、病程、肿瘤发生部位等一般资料比较,差异无统计学意义(P>0.05),具有可比性。术后行膝外侧方应力试验;摄X线片测量关节间隙,与健侧比较间隙增大程度并分级;参照美国骨与软组织肿瘤协会(MSTS)功能评分标准对关节功能进行评分。结果术后两组切口均Ⅰ期愈合。两组采用MalawerⅡ型手术切除者均发生医源性完全腓神经功能丧失。患者术后均获随访,随访时间12～36个月,平均30个月。试验组中1例纤维母细胞性骨肉瘤患者发生局部复发,12个月后死于肺部及全身转移;其余患者肿瘤均无复发。末次随访时,试验组膝外侧方应力试验均为阴性,关节间隙增大分级为A级;对照组应力试验均为阳性,分级为D级。试验组MSTS评分为(97.5±3.5)分,对照组为(87.5±3.5)分,两组比较差异有统计学意义(t=2.85,P=0.01)。结论腓骨近端肿瘤切除术后重建腓骨近端腓侧副韧带及股二头肌肌腱的骨性附着点,恢复了膝关节稳定性,利于关节功能重建。

Objective To investigate the method and the clinical outcomes of reconstruction of the knee stability after resection of tumors of the proximal fibula.Methods The clinical data were retrospectively analyzed,from 16 patients with tumors of the proximal fibula undergoing proximal fibular resections and reconstructions of the lateral collateral ligament and the tendon of the biceps femoris with anchors between January 2008 and December 2009（test group）.Five patients underwent proximal fibular resection but were not given reconstruction surgery at the same period as the control group.There was no significant difference in gender,ages,disease duration,and tumor site between 2 groups（P 0.05）.Lateral stress test was performed after operation;X-ray films were taken to measure the joint space.Musculoskeletal Tumor Society（MSTS） functional score system was used to evaluate the joint function.Results All incisions healed by first intention in 2 groups.Iatrogenic complete peroneal nerve function loss occurred in patients undergoing Malawer type II surgical resection.The patients in both groups were followed up 12 to 36 months,with an average of 30 months.One patient with osteosarcoma of the test group developed local recurrence,and died of lung and systemic metastases after 12 months;the other patients had no recurrence.At last follow-up,the results of knee lateral stress test were negative in the test group,and the joint space increased and was classified as grade A;the results of knee lateral stress test were positive in the control group,and the joint space was classified as grade D.The MSTS score was 97.5 ± 3.5 in the test group and 87.5 ± 3.5 in the control group,showing significant difference（t=2.85,P=0.01）.Conclusion The reconstruction of the bony attachment of the lateral collateral ligament and the tendon of the biceps femoris with anchors after resection of the proximal fibula is a safe,reliable,and simple technique to reconstruct knee stability after resection of tumors of the proximal fibula.