联合入路治疗踝关节弥漫性腱鞘滑膜巨细胞瘤

A combined posterolateral,anterolateral and anteromedial approach technique for diffuse tenosynovial giant cell tumors in the ankle:15 cases report

[目的]观察应用三切口（前内、前外、后外）任意组合联合入路的手术方式治疗踝关节弥漫性腱鞘滑膜巨细胞瘤的疗效。[方法]自2010年10月~2014年5月对15例踝关节弥漫性巨细胞瘤的患者采用三切口任意组合联合入路的手术入路方式进行肿块的完整切除术,并对损伤的韧带进行修复和对不稳定的关节进行固定,采用美国骨科足踝外科协会（AOFAS）踝关节功能评分系统进行评分。[结果]15患者获得12~40个月（平均28.3个月）的随访,患者均未复发,术后8个月踝关节功能AOFAS评分65~93分,平均分83.6分,其中优7例,良5例,一般3例,优良率80.2%。[结论]根据肿块具体位置来选择三切口任意组合联合入路的手术入路方式对踝关节弥漫性腱鞘滑膜巨细胞瘤进行彻底的病灶切除,可以有效地降低复发率,术中并对损伤的韧带和关节进行修复,以保证术后踝关节功能恢复良好。

[ Objective] To investigate the effects of combined posterolateral, anterolateral and anteromedial approaches technique for diffuse tenosynovial giant cell tumors in the ankle. [Methods] Fifteen patients with diffuse tenosynovial giant cell tumors in the ankle were admitted to our hospital form October 2010 to May 2015. The diffuse tenosynovial giant cell tumors were removed completely by combined posterolateral, anterolateral and anteromedial approaches, or any combination of two of them. Subsequently, the ligaments and joints damage were repaired. The functions of ankle were assessed by American Orthopae- dic Foot ＆ Ankle Society （AOFAS） scoring system. [ Results] A mean follow -up of 28. 3 （range, 12 to 40） months showed no re - occurrence of the tumor. The mean AOFAS score of the ankle function was 83.6 at 8 month after operation. The curative effects was graded as excellent in 7 cases , good in 5 and fair in 3, the overall good to excellent outcomes rate reached to 80. 2%. [ Conclusion] According to the specific location of tumor, combination of the three surgical approaches or any two of them would obtain complete excision of the tumor, thus reduce the recurrence rate effectively. Meanwhile, the ligaments and joints damage can be repaired definitely to ensure the post - surgery recovery of ankle function.