优化腓骨近端肿瘤切除术：“开门技术”为更好的手术进入和结果-一个病例系列。

IF 0.7 Q4 SURGERY

International Journal of Surgery Case Reports Pub Date : 2025-09-27 DOI:10.1016/j.ijscr.2025.111992

Sadegh Saberi , Hamed Naghizadeh , Sepand Heydari , Elham Poorghasem , Mehdi Bayati , Seyyed Saeed Khabiri

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引用次数: 0

摘要

目的：腓骨近端肿瘤由于靠近重要的神经血管结构，包括腓总神经，给外科手术带来了重大挑战。传统的切除技术通常需要广泛的组织操作，这可能导致腓神经损伤和膝关节不稳定等并发症。本研究介绍并评估了“开门技术”，该技术旨在增强手术的可视化和通路，从而减少并发症，同时实现肿瘤控制。方法：对2015年至2022年31例采用“开门技术”行腓骨近端肿瘤切除术的患者进行回顾性队列研究。记录了患者人口统计学、肿瘤特征和功能结局。采用术前影像学检查和标准化手术方法，随访评估包括肌肉骨骼肿瘤协会（MSTS）评分和多伦多肢体挽救评分（TESS）。采用描述性统计和比较分析来评估手术和功能结果。结果：在36个月的随访中，93.5%的病例采用“开门技术”获得了阴性切缘，复发率为6.5%。术后并发症包括12.9%的患者永久性腓神经损伤和9.7%的患者一过性神经损伤，两者均低于传统技术的发生率。功能结果良好，87.1%的患者获得良好至优秀的MSTS和TESS评分，表明实用的神经血管和韧带结构保存。结论：“开门技术”为腓骨近端肿瘤切除术提供了一种有效的、功能保留的方法，在肿瘤控制与减少神经血管并发症和改善功能预后之间取得了平衡。这些发现支持了它作为骨科肿瘤学实践中有价值的补充的潜力。建议进一步研究以证实其在更广泛的患者群体中的适用性。

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Optimizing proximal fibula tumor resection: “The open door technique” for better surgical access and outcomes - A case series

Objective

Proximal fibula tumors pose significant surgical challenges due to their proximity to vital neurovascular structures, including the common peroneal nerve. Traditional resection techniques often require extensive tissue manipulation, which can lead to complications such as peroneal nerve injury and knee instability. This study introduces and evaluates the “open door technique,” designed to enhance surgical visualization and access, thereby reducing complications while achieving oncologic control.

Methods

We conducted a retrospective cohort study of 31 patients who underwent proximal fibula tumor resection using the “open door technique” from 2015 to 2022. Patient demographics, tumor characteristics, and functional outcomes were documented. Preoperative imaging and a standardized surgical approach were employed, with follow-up assessments including the Musculoskeletal Tumor Society (MSTS) score and the Toronto Extremity Salvage Score (TESS). Descriptive statistics and comparative analyses were applied to evaluate surgical and functional outcomes.

Results

The “open door technique” achieved negative resection margins in 93.5 % of cases, with a recurrence rate of 6.5 % over a mean follow-up period of 36 months. Postoperative complications included permanent peroneal nerve injury in 12.9 % of patients and transient nerve injury in 9.7 %, both lower than rates typically associated with traditional techniques. Functional outcomes were favorable, with 87.1 % of patients achieving good to excellent MSTS and TESS scores, indicating practical neurovascular and ligamentous structure preservation.

Conclusion

The “open door technique” provides an effective, function-sparing approach for proximal fibula tumor resection, balancing oncologic control with reduced neurovascular complications and improved functional outcomes. These findings support its potential as a valuable addition to orthopedic oncology practices. Further studies are recommended to confirm its applicability across a broader patient population.

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