腓骨小头切除对胫骨上段肿瘤人工关节重建保肢术疗效的影响分析

EVALUATION OF FIBULAR HEAD RESECTION IN PROSTHETIC REPLACEMENT FOR NEOPLASMS OF PROXIMAL TIBIA IN LIMB SALVAGE SURGERY

目的 探讨胫骨上段肿瘤行人工关节重建保肢术中切取腓骨小头对疗效的影响。方法 1999年7月-2013年3月,收治76例胫骨上段肿瘤患者行保肢术。术中行瘤段切除、人工全膝关节重建,腓肠肌内侧头肌瓣敷盖,其中38例同时切除腓骨小头（A组）,38例保留腓骨小头（B组）。两组患者性别、年龄、侧别、肿瘤类型及分期、病程比较,差异均无统计学意义（P〉0.05）,具有可比性。观察比较两组术后相关并发症发生情况,X线片观察假体位置,采用1993年美国骨肿瘤学会评分系统（MSTS93）评定关节功能。结果 患者均获随访,随访时间12～150个月,平均87个月。术后A组1例（2.63%）发生切口感染,显著低于B组6例（15.79%（）χ2=3.934,P=0.047）。A组1例、B组2例发生腓肠肌内侧头坏死。X线片复查示A组4例、B组6例发生假体松动;A组2例、B组4例存在膝关节不稳。A组3例、B组5例肿瘤局部复发,A组7例、B组6例发生远处转移,A组8例、B组7例因肿瘤复发死亡。术后12个月,根据MSTS93评分系统,A组获优23例,良10例,中3例,差2例,优良率为86.84%;B组获优21例,良11例,中3例,差3例,优良率为84.21%。两组优良率比较,差异无统计学意义（χ2=0.106,P=0.744）。结论 胫骨上段肿瘤行人工关节重建保肢手术时,切除腓骨小头有利于术中软组织覆盖,可减少植皮术创伤及相应并发症,降低术后感染率,术后关节稳定性及活动度良好。

Objective To investigate the effects of fibular head resection in prosmetlc repiacement for neoplasms of the proximal tibia in limb salvage surgery. Methods Between July 1999 and March 2013, 76 patients with neoplasms of the proximal tibia underwent tumor resection, prosthetic replacement, and gastrocnemius medial head flap transfer. Among them, 38 patients underwent fibular head resection （group A） and 38 underwent fibular head preservation （group B）. There was no significant difference in gender, age, side, tumor classification and stage, and disease duration between 2 groups （P〉0.05）. The complications and the position of the components were observed, and American society for bone tumors scoring system （MSTS93） was used to evaluate the joint function. Results All patients were followed up 12-150 months （mean, 87 months）. Incision infection occurred in 1 patient （2.63%） of group A and 6 patients （15.79%） of group B, showing significant difference （X2=3.934, P=0,047）. Necrosis of gastrocnemius medial head flap was found in 1 patient of group A and 2 patients of group B. Prosthetic loosening and instability of the knee were observed in 4 and 2 cases of group A and in 6 and 4 cases of group B, respectively. In groups A and B, there were 3 and 5 cases of local recurrence, 7 and 6 cases of distant metastasis, and 8 and 7 deaths, respectively. According to MSTS93, the results were excellent in 23 cases, good in 10 cases, fair in 3 cases, and poor in 2 cases, with an excellent and good rate of 86.84% in group A; the results were excellent in 21 cases, good in 11 cases, fair in 3 cases, and poor in 3 cases, with an excellent and good rate of 84.21% in group B; and no significant difference was found in the excellent and good rate between 2 groups （X2=0.106, P=0.744）. Conclusion Fibular head resection in prosthetic replacement for neoplasms of the proximal tibia in limb salvage surgery is beneficial to intra-operative tissue coverage,and it can reduce trauma by skin transplantation and related complications. Good stability and motion of the joint can be obtained after operation.