踝关节内侧截骨治疗骨肿瘤疗效及对下肢关节功能的影响

Efficacy of medial ankle osteotomy in the treatment of bone tumors and its influence on lower limb joint function

目的 探究踝关节内侧截骨治疗骨肿瘤疗效及对下肢关节功能的影响。方法 选取2010年3月—2020年3月我院收治的139例骨肿瘤患者,其中接受踝关节内侧截骨术治疗53例,接受距骨开窗骨瘤刮除术治疗86例。采用非随机同期对照试验方法对所有纳入患者基线资料进行二元Logistics回归建立倾向性得分模型,最终获得基线资料统计学无意义的患者共113例,截骨组49例,对照组64例。评价两组患者术后6个月疗效,比较术前、术后6个月两组患者血清相关指标[血管性血友病因子(VvWF)、胸腺肽α1(Tα1)],骨创伤及愈合指标[乳酸脱氢酶(LDH)、碱性成纤维生长因子(bFGF)],血液流变学[纤维蛋白原(FIB)、血沉(ESR)],下肢关节功能[国际骨与软组织肿瘤协会功能评分(MSTS)],运动功能[Fugl-Meyer运动功能量表(FMA)]。结果 术后6个月,两组患者总有效率比较差异无统计学意义(P>0.05);术后6个月,两组患者血清相关指标(vWF、Tα1)、骨创伤及愈合指标(LDH)、血液流变学指标(FIB、ESR)均低于术前,且截骨组低于对照组(均P<0.05);术后6个月,两组患者bFGF、下肢关节功能(MSTS)、运动功能(FMA)量表中平衡功能、四肢感觉得分显著高于术前(均P<0.05),其他指标组间比较差异无统计学意义(均P>0.05)。结论 骨肿瘤患者行踝关节内侧截骨术疗效确切,术后下肢关节及运动功能恢复较好,具有一定临床应用价值。

Objective To explore the efficacy of medial ankle osteotomy on bone tumors and its influence on lower limb joint function.Methods Based on the sample size estimation,139 patients with bone tumors who were treated in the hospital were selected from March 2010 to March 2020,including 53 casesreceiving medial ankle osteotomy(osteotomy group)and 86 cases undergoing osteoma curettage with talus fenestration(control group).Non-randomized concurrent control trial was used to establish the propensity score model for baseline data of all included patients by binary logistics regression.Finally,a total of 113 patients in the two groups with no statistical significance in the baseline data were obtained,including 49 cases in osteotomy group and 64 cases in control group.The efficacy of the two groups of patients was evaluated at 6 months after surgery,and the levels of serum related indicators[von Willebrand factor(vWF),thymosinα1(Tα1)],bone trauma and healing indicators[lactate dehydrogenase(LDH),basic fibroblast growth factor(bFGF)]and hemorheology[fibrinogen(FIB),erythrocyte sedimentation rate(ESR)],lower extremity joint function[International Musculoskeletal Tumour Society Score(MSTS)]and motor function[Fugl-Meyer Assessment Scale(FMA)]were compared between the two groups before surgery and at 6 months after surgery.Results At 6 months after surgery,there was no statistical difference in the total effective rate between the two groups of patients(P>0.05).The levels of serum related indicators(vWF,Tα1),bone trauma and healing indicator(LDH)and hemorheological indicators(FIB,ESR)of the two groups of patients were significantly lower than those before surgery,and the levels of osteotomy group were significantly lower than those of control group(all P<0.05).The bFGF and scores of lower limb joint function(MSTS)and motor function(FMA)were significantly higher than those before surgery,and the scores of FMA(balance function and limb sensation)in osteotomy group were significantly higher than those in control group(all P<0.05),but there were no statistical differences in other indicators between the groups(all P>0.05).Conclusion Medial ankle osteotomy has definite efficacy and good recovery of postoperative lower limb joint function and motor function of patients with bone tumors,and it can effectively help the bone healing and blood circulation recovery.