• 上海交通大學(xué)附屬第六人民醫(yī)院骨科（上海，200233）;

目的 探討腓骨近端腫瘤切除術(shù)后重建膝關(guān)節(jié)穩(wěn)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(cè)副韌帶和股二頭肌肌腱骨性止點(diǎn)的16 例腓骨近端腫瘤患者（試驗(yàn)組）臨床資料，與同期5 例未行韌帶骨性重建患者（對照組）進(jìn)行比較。兩組患者性別、年齡、病程、腫瘤發(fā)生部位等一般資料比較，差異無統(tǒng)計(jì)學(xué)意義（P  gt; 0.05），具有可比性。術(shù)后行膝外側(cè)方應(yīng)力試驗(yàn)；攝X 線片測量關(guān)節(jié)間隙，與健側(cè)比較間隙增大程度并分級；參照美國骨與軟組織腫瘤協(xié)會（MSTS）功能評分標(biāo)準(zhǔn)對關(guān)節(jié)功能進(jìn)行評分。 結(jié)果 術(shù)后兩組切口均Ⅰ期愈合。兩組采用Malawer Ⅱ型手術(shù)切除者均發(fā)生醫(yī)源性完全腓神經(jīng)功能喪失。患者術(shù)后均獲隨訪，隨訪時(shí)間12 ～ 36 個(gè)月，平均30 個(gè)月。試驗(yàn)組中1 例纖維母細(xì)胞性骨肉瘤患者發(fā)生局部復(fù)發(fā)，12 個(gè)月后死于肺部及全身轉(zhuǎn)移；其余患者腫瘤均無復(fù)發(fā)。末次隨訪時(shí)，試驗(yàn)組膝外側(cè)方應(yīng)力試驗(yàn)均為陰性，關(guān)節(jié)間隙增大分級為A 級；對照組應(yīng)力試驗(yàn)均為陽性，分級為D級。試驗(yàn)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(tǒng)計(jì)學(xué)意義（t=2.85，P=0.01）。 結(jié)論 腓骨近端腫瘤切除術(shù)后重建腓骨近端腓側(cè)副韌帶及股二頭肌肌腱的骨性附著點(diǎn)，恢復(fù)了膝關(guān)節(jié)穩(wěn)定性，利于關(guān)節(jié)功能重建。

引用本文： 張春林 ,趙世昌,朱忠勝,孫佼,董揚(yáng),曾炳芳. 腓骨近端腫瘤切除術(shù)后膝關(guān)節(jié)穩(wěn)定性重建的臨床研究. 中國修復(fù)重建外科雜志, 2012, 26(4): 441-444. doi: 復(fù)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(shù)治療及對膝關(guān)節(jié)穩(wěn)定性影響的研究進(jìn)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(qiáng), 楊榮利, 郭衛(wèi). 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. 1. Dahlin DC. Bone tumours: general aspects and data on 6221 Cases. 3rd ed. Springfield: Charles C Thomas Pub Ltd, 1978: 11-12.
  2. 2. Unni KK. Dahlin bone tumors: Bone tumors general aspects and data on 11087 cases. Illinois: Lippincott-Raven, 1996: 172-264.
  3. 3. 趙世昌, 張春林. 腓骨近端腫瘤的手術(shù)治療及對膝關(guān)節(jié)穩(wěn)定性影響的研究進(jìn)展. 中國骨腫瘤骨病, 2011, 10(2): 204-208.
  4. 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. 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. 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. 7. 燕太強(qiáng), 楊榮利, 郭衛(wèi). 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. 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. 9. Malawer MM. Surgical management of aggressive and malignant tumors of the proximal fibula. Clin Orthop Relat Res, 1984, (186): 172-181.
  10. 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. 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. 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. 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. 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. 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. 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. 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. 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.