腓骨近端腫瘤切除術后膝關節穩定性重建的臨床研究_《中國修復重建外科雜志》

作者：

張春林 , 趙世昌 , 朱忠勝 , 孫佼 , 董揚 , 曾炳芳

上海交通大學附屬第六人民醫院骨科（上海，200233）;

關鍵詞：

腓骨近端腫瘤膝關節穩定性功能重建

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目的探討腓骨近端腫瘤切除術后重建膝關節穩定性的方法及臨床療效。方法回顧分析2008 年1 月－ 2009 年12 月行近端腓骨切除并重建腓側副韌帶和股二頭肌肌腱骨性止點的16 例腓骨近端腫瘤患者（試驗組）臨床資料，與同期5 例未行韌帶骨性重建患者（對照組）進行比較。兩組患者性別、年齡、病程、腫瘤發生部位等一般資料比較，差異無統計學意義（P gt; 0.05），具有可比性。術后行膝外側方應力試驗；攝X 線片測量關節間隙，與健側比較間隙增大程度并分級；參照美國骨與軟組織腫瘤協會（MSTS）功能評分標準對關節功能進行評分。結果術后兩組切口均Ⅰ期愈合。兩組采用Malawer Ⅱ型手術切除者均發生醫源性完全腓神經功能喪失。患者術后均獲隨訪，隨訪時間12 ～ 36 個月，平均30 個月。試驗組中1 例纖維母細胞性骨肉瘤患者發生局部復發，12 個月后死于肺部及全身轉移；其余患者腫瘤均無復發。末次隨訪時，試驗組膝外側方應力試驗均為陰性，關節間隙增大分級為A 級；對照組應力試驗均為陽性，分級為D級。試驗組MSTS 評分為（97.5 ± 3.5）分，對照組為（87.5 ± 3.5）分，兩組比較差異有統計學意義（t=2.85，P=0.01）。結論腓骨近端腫瘤切除術后重建腓骨近端腓側副韌帶及股二頭肌肌腱的骨性附著點，恢復了膝關節穩定性，利于關節功能重建。

引用本文： 張春林 ,趙世昌,朱忠勝,孫佼,董揚,曾炳芳. 腓骨近端腫瘤切除術后膝關節穩定性重建的臨床研究. 中國修復重建外科雜志, 2012, 26(4): 441-444. doi: 復制

1.	Dahlin DC. Bone tumours: general aspects and data on 6221 Cases. 3rd ed. Springfield: Charles C Thomas Pub Ltd, 1978: 11-12.
2.	Unni KK. Dahlin bone tumors: Bone tumors general aspects and data on 11087 cases. Illinois: Lippincott-Raven, 1996: 172-264.
3.	趙世昌, 張春林. 腓骨近端腫瘤的手術治療及對膝關節穩定性影響的研究進展. 中國骨腫瘤骨病, 2011, 10(2): 204-208.
4.	Capanna R, Scoccianti G, Campanacci DA, et al. Surgical technique: extraarticular knee resection with prosthesis-proximal tibia-extensor apparatus allograft for tumors invading the knee. Clin Orthop Relat Res, 2011, 469(10): 2905-2914.
5.	Saini R, Bali K, Gill SS, et al. En bloc resection of osteosarcoma of the proximal fibula. An analysis of 8 cases. Acta Orthop Belg, 2010, 76(6): 806-810.
6.	Mootha AK, Saini R, Dhillon M, et al. Modified resection technique for proximal fibular osteochondromas. Orthop Traumatol Surg Res, 2011, 97(5): 569-573.
7.	燕太強, 楊榮利, 郭衛. 腓骨近端成骨肉瘤的外科治療. 中華外科雜志, 2008, 46(9): 661-663.
8.	Dieckmann R, Gebert C, Streitbürger A, et al. Proximal fibula resection in the treatment of bone tumours. Int Orthop, 2011, 35(11): 1689-1694.
9.	Malawer MM. Surgical management of aggressive and malignant tumors of the proximal fibula. Clin Orthop Relat Res, 1984, (186): 172-181.
10.	LaPrade RF, Heikes C, Bakker AJ, et al. The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg (Am), 2008, 90(10): 2069-2076.
11.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedure after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
12.	Bickels J, Kollender Y, Pritsch T, et al. Knee stability after resection of the proximal fibula. Clin Orthop Relat Res, 2007, 454: 198-201.
13.	Coobs BR, LaPrade RF, Griffith CJ, et al. Biomechanical analysis of an isolated fibular (lateral) collateral ligament reconstruction using an autogenous semitendinosus graft. Am J Sports Med, 2007, 35(9): 1521-1527.
14.	Abdel MP, Papagelopoulos PJ, Morrey ME, et al. Surgical management of 121 benign proximal fibula tumors. Clin Orthop Relat Res, 2010, 468(11): 3056-3062.
15.	Provencher MT, Ryu JH, Gaston T, et al. Technique: bone-patellar tendon-bone autograft ACL reconstruction in the young, active patient. J Knee Surg, 2011, 24(2): 83-92.
16.	Shino K, Mae T, Nakamura N. Surgical technique: revision ACL reconstruction with a rectangular tunnel technique. Clin Orthop Relat Res, 2012, 470(3): 843-852.
17.	Kang H, Wang F. The modified bone-patellar tendon-bone allograft in single-bundle anterior cruciate ligament reconstruction. Acta Orthop Belg, 2011, 77(3): 390-393.
18.	Daigeler A, Drücke D, Tatar K, et al. The pedicled gastrocnemius muscle flap: a review of 218 cases. Plast Reconstr Surg, 2009, 123(1): 250-257.

1. Dahlin DC. Bone tumours: general aspects and data on 6221 Cases. 3rd ed. Springfield: Charles C Thomas Pub Ltd, 1978: 11-12.
2. Unni KK. Dahlin bone tumors: Bone tumors general aspects and data on 11087 cases. Illinois: Lippincott-Raven, 1996: 172-264.
3. 趙世昌, 張春林. 腓骨近端腫瘤的手術治療及對膝關節穩定性影響的研究進展. 中國骨腫瘤骨病, 2011, 10(2): 204-208.
4. Capanna R, Scoccianti G, Campanacci DA, et al. Surgical technique: extraarticular knee resection with prosthesis-proximal tibia-extensor apparatus allograft for tumors invading the knee. Clin Orthop Relat Res, 2011, 469(10): 2905-2914.
5. Saini R, Bali K, Gill SS, et al. En bloc resection of osteosarcoma of the proximal fibula. An analysis of 8 cases. Acta Orthop Belg, 2010, 76(6): 806-810.
6. Mootha AK, Saini R, Dhillon M, et al. Modified resection technique for proximal fibular osteochondromas. Orthop Traumatol Surg Res, 2011, 97(5): 569-573.
7. 燕太強, 楊榮利, 郭衛. 腓骨近端成骨肉瘤的外科治療. 中華外科雜志, 2008, 46(9): 661-663.
8. Dieckmann R, Gebert C, Streitbürger A, et al. Proximal fibula resection in the treatment of bone tumours. Int Orthop, 2011, 35(11): 1689-1694.
9. Malawer MM. Surgical management of aggressive and malignant tumors of the proximal fibula. Clin Orthop Relat Res, 1984, (186): 172-181.
10. LaPrade RF, Heikes C, Bakker AJ, et al. The reproducibility and repeatability of varus stress radiographs in the assessment of isolated fibular collateral ligament and grade-III posterolateral knee injuries. An in vitro biomechanical study. J Bone Joint Surg (Am), 2008, 90(10): 2069-2076.
11. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedure after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
12. Bickels J, Kollender Y, Pritsch T, et al. Knee stability after resection of the proximal fibula. Clin Orthop Relat Res, 2007, 454: 198-201.
13. Coobs BR, LaPrade RF, Griffith CJ, et al. Biomechanical analysis of an isolated fibular (lateral) collateral ligament reconstruction using an autogenous semitendinosus graft. Am J Sports Med, 2007, 35(9): 1521-1527.
14. Abdel MP, Papagelopoulos PJ, Morrey ME, et al. Surgical management of 121 benign proximal fibula tumors. Clin Orthop Relat Res, 2010, 468(11): 3056-3062.
15. Provencher MT, Ryu JH, Gaston T, et al. Technique: bone-patellar tendon-bone autograft ACL reconstruction in the young, active patient. J Knee Surg, 2011, 24(2): 83-92.
16. Shino K, Mae T, Nakamura N. Surgical technique: revision ACL reconstruction with a rectangular tunnel technique. Clin Orthop Relat Res, 2012, 470(3): 843-852.
17. Kang H, Wang F. The modified bone-patellar tendon-bone allograft in single-bundle anterior cruciate ligament reconstruction. Acta Orthop Belg, 2011, 77(3): 390-393.
18. Daigeler A, Drücke D, Tatar K, et al. The pedicled gastrocnemius muscle flap: a review of 218 cases. Plast Reconstr Surg, 2009, 123(1): 250-257.

《中國修復重建外科雜志》

腓骨近端腫瘤切除術后膝關節穩定性重建的臨床研究

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《中國修復重建外科雜志》

腓骨近端腫瘤切除術后膝關節穩定性重建的臨床研究

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