Biological Reconstruction Following Distal Tibia Tumor Resection: A Comparative Analysis of Fibula Translocation and Extracorporeal Radiotherapy Autograft.
Abhijit Behera, Love Kapoor, Venkatesan Sampath Kumar, Sameer Bakhshi, Shah Alam Khan
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引用次数: 0
Abstract
Background: Reconstruction following distal tibia tumor resection presents challenges in achieving stable skeletal support and functional restoration. Various biological reconstruction techniques, including fibula translocation and extracorporeal radiotherapy (ECRT) autograft, have been utilized. This study compares the clinical, radiological, and functional outcomes of these techniques to determine the optimal approach.
Methods: A retrospective observational study was conducted on 17 patients who underwent distal tibia tumor resection and biological reconstruction between 2007 and 2022, with a mean follow-up of 62.1 ± 38.6 months. Ten patients received fibula translocation with plate fixation, while seven underwent ECRT autograft reconstruction (four with plate fixation and three with hindfoot nail fixation). Radiological union times, weight-bearing progression, functional scores, and complications were analyzed.
Results: ECRT autografts demonstrated a trend towards faster radiological union at both proximal (14.14 ± 3.29 vs. 22.10 ± 1.79 months, p < 0.001) and distal junctions (8.43 ± 1.90 vs. 11.60 ± 1.26 months, p = 0.001). Earlier weight-bearing initiation was observed in ECRT patients (10.79 ± 5.82 vs. 36.90 ± 5.17 weeks, p < 0.001). Time to full weight-bearing was shorter in the ECRT group (19.86 ± 10.10 vs. 57.00 ± 9.76 weeks, p < 0.001). Within the ECRT subgroup, a faster full weight-bearing trend was observed with hindfoot nail fixation as compared to plate fixation (9.33 ± 1.04 vs. 27.75 ± 3.10 weeks, p < 0.001). Functional outcomes remained comparable between groups.
Conclusion: ECRT reconstruction facilitates earlier union and weight-bearing compared to fibula translocation. Hindfoot nail fixation further accelerates rehabilitation. While both techniques yield similar functional outcomes, ECRT autograft reconstruction may be preferred for its biomechanical and rehabilitative advantages.
背景：胫骨远端肿瘤切除后的重建在实现稳定的骨骼支持和功能恢复方面提出了挑战。各种生物重建技术，包括腓骨移位和体外放疗（ECRT）自体移植，已被应用。本研究比较了这些技术的临床、放射学和功能结果，以确定最佳方法。方法：回顾性观察2007 - 2022年间17例胫骨远端肿瘤切除及生物重建患者，平均随访62.1±38.6个月。10例患者行腓骨移位钢板固定，7例行ECRT自体移植物重建（4例钢板固定，3例后脚钉固定）。分析放射学愈合时间、负重进展、功能评分和并发症。结果：自体ECRT移植近端放射愈合更快（14.14±3.29个月比22.10±1.79个月，p p = 0.001）。ECRT患者负重开始时间较早（10.79±5.82周vs. 36.90±5.17周），p p p p结论：与腓骨移位相比，ECRT重建有助于早期愈合和负重。后脚甲内固定进一步加速康复。虽然这两种技术产生相似的功能结果，但ECRT自体移植物重建可能因其生物力学和康复优势而受到青睐。证据等级：三级。
期刊介绍：
IJO welcomes articles that contribute to Orthopaedic knowledge from India and overseas. We publish articles dealing with clinical orthopaedics and basic research in orthopaedic surgery. Articles are accepted only for exclusive publication in the Indian Journal of Orthopaedics. Previously published articles, articles which are in peer-reviewed electronic publications in other journals, are not accepted by the Journal. Published articles and illustrations become the property of the Journal. The copyright remains with the journal. Studies must be carried out in accordance with World Medical Association Declaration of Helsinki.
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