儿童腓骨远端肿瘤的临床处理

Abstract

目的：观察9例儿童腓骨远端肿瘤患者手术治疗后的临床疗效和功能评定。方法：2011年6月~2014年9月期间9例儿童腓骨远端肿瘤患者获得术后随访。PubMed搜索使用术语“腓骨”，“下肢肿瘤(癌症)”，“肉瘤”、“尤文氏肉瘤”、“腓骨的”、“腓骨转移”。结果：所有患者均为单侧病变并获得随访，平均随访3.6 ± 1.5年；所有患者诉有疼痛，其中9例患者中5例出现疼痛及跛行。除了1例接受放疗外其他患者均进行手术处理。在6位患者中，1例为良性的肿瘤或肿瘤样变。2例恶性肺腺癌转移及1例多病灶的间质肿瘤。腓骨治疗性病灶清除后进行植骨，然后进行内固定处理术后没有恶变。在恶性或活动期病变中进行腓骨瘤段切除。文献检索中无论是案例报告还是小案例系列，均反映出腓骨远端的肿瘤较为罕见。在所有良性病变患者中手术治疗是成功的，而恶性肿瘤的成功率为40%~100%。结论：腓骨远端肿瘤的发病率低，最佳手术治疗方案存在争议。无症状的良性病变应进行临床观察及定期影像学检查随访。在非恶性肿瘤出现疼痛，跛行，病理骨折及恶性肿瘤时建议手术治疗。最后，在无症状患者或疾病诊断不确定时应进行穿刺活检或病理组织学检查。 Objective: To study the clinical and functional outcomes of surgical treatment in a case series of nine patients with distal fibular tumours. Method: Nine patients with distal fibular tumours were followed up and observed between June 2011 and September 2014. A PubMed search was per-formed using the terms “fibula”, “lower limb tumour (cancer)”, “sarcoma”, “Ewing”, “peroneal”, “fibular metastasis”. Result: All cases were followed-up for 3.6 ± 1.5 years. In all our patients, lesions were unilateral. All patients complained of pain; limping was present in 5 of 9 patients. Patients were managed surgically, except one who underwent local radiotherapy. In six patients, a benign or tumor-like lesion was detected. Malignancies consisted of metastatic lung adenocarcinoma (two cases) or multifocal mesenchymal cancer (one case). Non-malignant lesions were treated by curettage and filling, followed by internal fixation when needed. In malignant or locally aggressive lesions, metadiaphyseal fibular resection was performed. The literature search retrieved either case reports or small case series, reflecting the rarity of distal fibular tumours. Surgical treatment was successful in all patients with benign lesions, whereas the rate of success was 40% - 100% in case of malignancies. Conclusion: Given the low incidence of distal fibular tumours, controversies exist about the optimal surgical management. Clinical observation and imaging should be reserved to asymptomatic benign lesions. In non-malignant tumours causing pain,, limping, and pathological fractures and malignancies, surgery is recommended. Finally, in patients with asymptomatic lesions of uncertain nature, biopsy and histological examination should be performed to plan appropriate management.