腓骨近端骨肉瘤18例手术治疗临床分析

目的 探讨腓骨近端骨肉瘤手术治疗方式、术后并发症及处理策略。方法 回顾分析2007年1月—2016年1月解放军东部战区总医院骨科收治腓骨近端骨肉瘤18例,其中男11例、女7例,年龄8~38岁(中位年龄17岁)。18例患者均主诉疼痛,伴有腓总神经麻痹症状8例、包块3例;病程1~24周。Enneking外科分期ⅡB期17例,Ⅲ期1例。18例患者中,15例给予新辅助化疗后行腓骨近端骨肉瘤切除术,其中Malawer type Ⅰ型切除13例、Ⅱ型切除2例;2例患者外院切除不完整,入院后选择截肢手术;1例患者(Ⅲ期)入院时已发生肺转移,给予2个疗程化疗后原发肿瘤继续生长,疼痛无缓解,予以截肢手术。术后3个月采用骨骼肌系统肿瘤协会(MSTS)评分系统评价15例保肢患者膝关节功能。结果 18例患者术后均获得随访,随访时间7~120个月。发生肺转移8例,死亡5例(包括3例截肢患者)。15例行腓骨近端骨肉瘤切除保肢手术的患者中复发4例,均行截肢术;1例出现术后伤口感染,给予积极加强换药,伤口正常愈合;5例出现腓总神经损伤,其中2例分别于术后3、7个月自行恢复,1例遗留轻度跛行,2例出现足下垂需佩踝关节支具行走。15例患者接受保肢手术后皆未出现膝关节不稳症状,术后3个月MSTS功能评分,11例良好、2例一般、2例差。结论 对于腓骨近端骨肉瘤的治疗,选择正确的手术方式至关重要;根据肿瘤侵犯范围决定手术方式,腓骨近端骨肉瘤术后并发症患者可接受。术中膝关节外侧副韧带及股二头肌外侧头原位缝合即可获得膝关节稳定。

Surgical treatment of proximal fibula osteosarcoma: a report of 18 cases

Objective To explore surgical modalities, postoperative complications and management strategies of proximal fibula osteosarcoma (PFOS).Methods Eighteen patients of PFOS admitted in our center between January 2007 to January 2016 were retrospective analyzed, including 11 male patients and 7 female patients with a median age of 17 (range 8-38) years. All the 18 patients reported pain as the chief complaint, including 8 patients with accompanying symptoms of common peroneal nerve paralysis,and 3 patients with masses. The median duration of disease was 1-24 weeks. According to Enneking surgical classification,there were 17 cases in stage ⅡB and one case in stage Ⅲ.Fifteen patients underwent neoadjuvant chemotherapy for proximal humeral osteosarcoma resection, including 13 cases of Malawer type Ⅰ resection and 2 cases of type Ⅱ resection. There were 2 patients with incomplete resection in other hospitals who were amputation after admission. One patient (stage Ⅲ) had lung metastasis at the time of admission. After two courses of chemotherapy, the primary tumor continued to grow, and the pain was not relieved. Amputation was performed. The knee joint function of 15 patients with limb salvage was evaluated using the Musculo Skeletal Tumor Society(MSTS) scoring system in 3 months after operation.Results All the 18 PFOS patients were followed up successfully for a mean of 59 (range 7-120) months, during which lung metastasis occurred in 8 patients, and death occurred in 5 patients(including 3 cases of amputation). Of the 15 patients with limb salvage, recurrence occurred in 4 patients; postoperative wound infection occurred in one patient which was cured after positive and intensified dressing change. Common peroneal nerve injury occurred in 5 patients, and two of them recovered spontaneously in 3 and 7 months after operation. One patient had mild lameness and two patients had perforation of the perforation. No knee joint instability occurred in all these 15 patients. MSTS function scores in 3 months after operation were good in 11 cases, moderate in 2 cases, and poor in 2 cases.Conclusions Correct selection of the initial surgical modality for the treatment of PFOS is critical. Surgical procedures are determined according to the extent of tumor invasion,and postoperative complications of proximal fibular osteosarcoma are acceptable. Knee joint stability can be achieved by simple in situ suturing of the knee joint lateral collateral ligament and the lateral head of the biceps femoris muscle.