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[目的]回顾性分析累及腓骨近端原发恶性肿瘤患者的病历资料,探讨其保肢技术,总结其肿瘤学结果、并发症及术后功能情况。[方法]2002年10月~2014年12月,共有14例累及腓骨近端原发恶性肿瘤患者于本院接受保肢治疗,男9例,女5例;年龄9~61岁,平均23.20岁。骨肉瘤9例,软骨肉瘤2例,尤文肉瘤2例,纤维肉瘤1例。14例患者均首诊于本院,术前均行穿刺活检明确病理,均符合并接受保肢手术治疗,其中9例骨肉瘤患者接受了4~6周期新辅助化疗(术前2周期),化疗方案以阿霉素、顺铂、大剂量氨甲喋呤、异环磷酰胺为主。依据Enneking分期,处于ⅡA期病例4例,采用Malawer-Ⅰ型切除。ⅡB期病例10例采用Malawer-Ⅱ型切除。[结果]随访时间18~164个月,平均36.20个月。5例术后局部复发,其中Malawer-Ⅱ型切除的2例(2/10),Malawer-Ⅰ型切除的3例(3/4)。4例患者死于肺转移,其中Malawer-Ⅱ型切除的2例(2/10),Malawer-Ⅰ型切除的2例(2/4)。所有患者经膝关节股二头肌肌腱及外侧副韧带止点重建后,膝关节功能均稳定。对于腓总神经切除的患者佩戴踝关节外固定支具行走。多数患者疼痛缓解,不影响日常生活活动。国际骨肿瘤协会(musculoskeletal tumor society,MSTS)评分14~26分.平均21.9分(73%)。[结论]累及腓骨近端原发恶性肿瘤,由于其解剖学特点,多数发现时已处于Enneking分期ⅡB期,选择保肢技术时,应尽量获得足够的手术边界,以期获得良好的肿瘤学结果。
[Objective] To retrospectively analyze the medical records of patients with primary malignant tumors of the proximal fibula, discuss the limb salvage techniques and summarize their oncology results, complications and postoperative functional status. [Methods] From October 2002 to December 2014, a total of 14 patients with primary malignant tumors involving the proximal fibula underwent limb salvage in our hospital. There were 9 males and 5 females, aged 9-61 years old (mean, 23.20 years) . Osteosarcoma in 9 cases, 2 cases of chondrosarcoma, Ewing’s sarcoma in 2 cases, fibrosarcoma in 1 case. All 14 patients were admitted to our hospital first. All patients underwent biopsy to confirm the pathology. All of them were in compliance with the limb salvage surgery. Among them, 9 patients with osteosarcoma received 4 ~ 6 cycles of neoadjuvant chemotherapy (preoperative 2 cycles) Chemotherapy program to doxorubicin, cisplatin, high-dose methotrexate, ifosfamide based. According to Enneking staging, 4 cases were in stage IIA and were treated with Malawer-Ⅰ type excision. 10 cases of stage ⅡB were treated with Malawer-Ⅱ resection. [Results] The follow-up time ranged from 18 to 164 months with an average of 36.20 months. Five patients had local recurrence after surgery. Among them, 2 cases (2/10) were resected with Malawer-Ⅱ type and 3 cases (3/4) with Malawer-Ⅰ type resection. Four patients died of lung metastases, including 2 cases with Malawer-Ⅱ resection (2/10) and 2 cases with Malawer-Ⅰ resection (2/4). All patients with knee joint biceps tendon and lateral collateral ligament only point reconstruction, knee function are stable. For patients with common peroneal nerve removal ankle external fixation brace walking. Most patients with pain relief, does not affect daily life activities. The International Society of Bone Tumors (MSTS) scored 14 to 26, averaging 21.9 (73%). [Conclusion] Due to its anatomic characteristics, most of the primary malignant tumors involving the fibula have been in Enneking stage ⅡB for the majority of cases. Choosing the limb salvage technique should obtain enough surgical boundaries so as to obtain good oncology results.