Treatment of distal tibial tumor with vascularized fibula reconstruction_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LI Xiaoya ^1,2 , TENG Xiao ² , LIN Nong ¹ , YAN Xiaobo ¹ , LI Binghao ¹ ,  YE Zhaoming ¹

1. Department of Orthopaedics, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou Zhejiang, 310009, P.R.China;
2. Department of Orthopaedics, Taizhou Central Hospital, Taizhou Zhejiang, 318000, P.R.China;

Corresponding?author：

YE Zhaoming, Email: yezhaomz2@163.com

Keywords：

Distal tibial tumor; vascularized fibula; ankle; arthrodesis

DOI：

10.7507/1002-1892.202003088

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Objective To evaluate the effectiveness of vascularized fibula reconstruction in treatment of distal tibial malignant and invasive tumors.Methods Between March 2012 and January 2018, 11 patients with distal tibial malignant and invasive tumors were treated with vascularized fibula reconstruction. There were 7 males and 4 females with an average age of 20 years (range, 16-39 years). There were 8 cases of osteosarcoma, 2 cases of invasive giant cell tumor of bone, and 1 case of hemangioendothelioma. The tumors were rated as benign stage 3 in 2 cases and malignant stageⅠA in 1 case, stageⅡA in 4 cases, and stage ⅡB in 4 cases according to the Enneking staging. The disease duration was 1-6 months (mean, 2.7 months). The limb function was evaluated by Musculoskeletal Tumor Society (MSTS) score, and the distal and proximal union of the transplanted fibula and the diameter of the fibula were examined by imaging.Results All incisions healed by first intention. All patients were followed up 16-85 months (mean, 41 months). No tumor recurrence or metastasis occurred during the follow-up. The proximal and distal grafts in the 10 cases showed osseous healing, and the healing time was 7-12 months (mean, 10.1 months) at proximal end and 7-12 months (mean, 9.3 months) at distal end. In 1 case, the proximal end did not heal at 19 months, while the distal end healed at 13 months; proximal bone grafting was performed, and the proximal end healed. Among the 4 patients with distal screw fixation, 2 had peri-internal fixation fractures after graft healing, but no skin necrosis or infection occurred. All the 7 patients with distal steel plate fixation had no peri-internal fixation fracture, but 1 patient developed anterior tibial skin necrosis. At 12 months after operation, the diameter of fibula increased 1-5 mm (mean, 2.4 mm) by compared with that before operation. The MSTS score was 17-27 (mean, 22.8).Conclusion Reconstruction of ankle joint with vascularized fibula can achieve satisfactory functional results, which is one of the feasible and worthy methods for the distal tibial malignant and invasive tumors.

Citation： LI Xiaoya, TENG Xiao, LIN Nong, YAN Xiaobo, LI Binghao, YE Zhaoming. Treatment of distal tibial tumor with vascularized fibula reconstruction. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(10): 1221-1225. doi: 10.7507/1002-1892.202003088 Copy

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2.	李先安, 劉劍帆, 徐學政, 等. 牽拉成骨術治療脛骨遠端惡性腫瘤的療效評價. 中國骨與關節雜志, 2018, 7(2): 127-131.
3.	Chen WM, Wu PK, Chen CF, et al. High-grade osteosarcoma treated with hemicortical resection and biological reconstruction. J Surg Oncol, 2012, 105(8): 825-829.
4.	Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
5.	Renard AJ, Veth RP, Schreuder HW, et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol, 2000, 73(4): 198-205.
6.	郭衛, 牛曉輝, 肖建如, 等. 骨肉瘤臨床循證診療指南. 中華骨與關節外科雜志, 2018, 11(4): 288-301.
7.	Ajit Singh V, Nasirudin N, Bernatt M. Endoprosthetic reconstruction for giant cell tumors of the distal tibia: a short term review. Asia Pac J Clin Oncol, 2013, 9(2): 182-189.
8.	Zhao ZQ, Yan TQ, Guo W, et al. Surgical treatment of primary malignant tumours of the distal tibia: clinical outcome and reconstructive strategies. Bone Joint J, 2018, 100-B(12): 1633-1639.
9.	Shalaby S, Shalaby H, Bassiony A. Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator. J Bone Joint Surg (Br), 2006, 88(12): 1642-1646.
10.	Zhang C, Zeng B, Zhu K, et al. Limb salvage for malignant bone tumours of distal tibia with dual ipsilateral vascularized autogenous fibular graft in a trapezoid-shaped array with ankle arthrodesis and preserving subtalar joint. Foot Ankle Surg, 2019, 25(3): 278-285.

1. 趙坤, 王延嶺, 盧敏勛, 等. 脛骨下段大段瘤性骨缺損修復重建的研究進展. 中國修復重建外科雜志, 2018, 32(9): 1211-1217.
2. 李先安, 劉劍帆, 徐學政, 等. 牽拉成骨術治療脛骨遠端惡性腫瘤的療效評價. 中國骨與關節雜志, 2018, 7(2): 127-131.
3. Chen WM, Wu PK, Chen CF, et al. High-grade osteosarcoma treated with hemicortical resection and biological reconstruction. J Surg Oncol, 2012, 105(8): 825-829.
4. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
5. Renard AJ, Veth RP, Schreuder HW, et al. Function and complications after ablative and limb-salvage therapy in lower extremity sarcoma of bone. J Surg Oncol, 2000, 73(4): 198-205.
6. 郭衛, 牛曉輝, 肖建如, 等. 骨肉瘤臨床循證診療指南. 中華骨與關節外科雜志, 2018, 11(4): 288-301.
7. Ajit Singh V, Nasirudin N, Bernatt M. Endoprosthetic reconstruction for giant cell tumors of the distal tibia: a short term review. Asia Pac J Clin Oncol, 2013, 9(2): 182-189.
8. Zhao ZQ, Yan TQ, Guo W, et al. Surgical treatment of primary malignant tumours of the distal tibia: clinical outcome and reconstructive strategies. Bone Joint J, 2018, 100-B(12): 1633-1639.
9. Shalaby S, Shalaby H, Bassiony A. Limb salvage for osteosarcoma of the distal tibia with resection arthrodesis, autogenous fibular graft and Ilizarov external fixator. J Bone Joint Surg (Br), 2006, 88(12): 1642-1646.
10. Zhang C, Zeng B, Zhu K, et al. Limb salvage for malignant bone tumours of distal tibia with dual ipsilateral vascularized autogenous fibular graft in a trapezoid-shaped array with ankle arthrodesis and preserving subtalar joint. Foot Ankle Surg, 2019, 25(3): 278-285.

Chinese Journal of Reparative and Reconstructive Surgery

Treatment of distal tibial tumor with vascularized fibula reconstruction

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