Clinical Study On The Operative Classification Of Fibular Proximal Tumors And Functional Evaluation Of Knee And Ankle Joint

Objective: To retrospectively analysis the clinical curative effect of surgical treatment of proximal fibula tumor,and explore the proximal fibula tumor resection operation method as well as evaluation of the function and stability of the knee and ankle joint by the operation method.Methods: From July 2014 to February 2018,23 patients with proximal fibular tumors were admitted to our hospital,including 20 cases of primary tumor and 3 cases of recurrence.9 cases of osteochondroma,6 cases of giant cell tumor,2 cases of osteosarcoma,1 case of bone cyst,1 case of aneurysmal bone cyst,1 case of endogenous chondroma,1 case of chondrosarcoma,1 case of osteoblastoma,1 case of metastatic carcinoma.All cases were treated with fibula proximal tumor segmental resection.Surgical resection was determined according to the benign and malignant tumor,and the surgical typing was designed according to the surgical preservation or resection of the common peroneal nerve,intra-articular or extra-articular resection of the upper tibiofibular joint.Surgery is divided into four types.Type I retain the deep peroneal nerve,intra-articular resection of upper tibiofibular joint;Type II resection of the deep peroneal nerve,intra-articular resection of upper tibiofibular joint;Type III retention of the deep peroneal nerve,extra-articular resection of upper tibiofibular joint;Type IV resection of the deep peroneal nerve,extra-articular resection of the upper tibiofibular joint.Results:Of this group,23 cases of proximal fibula tumor were successfully operated,including type I 15 cases,type II 2 cases,type III 2 cases and type IV 4 cases.Type I contains 9 cases of osteochondroma,2 cases of giant cell tumor of bone,1 case of the bone cyst,1 case of endophytic chondroma,1 case of osteoblastoma and 1 case of chondrosarcoma.Type II consists of 1 case of giant cell tumor of bone,1 case of aneurysmal bone cyst.Type III comprises 1 case of primary giant cell tumor of bone and1 case of recurrent giant cell tumor of bone.Type IV includes 1 case of metastatic carcinoma,1 case of recurrent giant cell tumor of bone and 2 cases of osteosarcoma.Type I and Type III had proper ankle function because of preserving deep peroneal nerve,however,type II and type IV had a foot drop after removal of the deep peroneal nerve,and it was necessary to wear the ankle foot orthosis for a long time.Type I and Type II as the intra-articular upper tibiofibular joint resection,preserving the lateral collateral ligament,biceps femoris tendon,and popliteal tendon,partly to protect the knee joint lateral stable structure,better postoperative knee stability.Type III and Type IV extra-articular resection of the upper tibiofibular joint with resection of the lateral structures of the knee appeared different levels of structure state of instability of the knee joint.Conclusions:Since the peroneal nerve and the anterior tibial artery are adjacent to each other,therefore,there are still many challenges in the resection of proximal fibula tumors.Both Malawer and Erler types have certain limitations.The deep peroneal nerve and upper tibiofibular joint classification(DPN-PTFJ typing)can better implement surgical plan and postoperative functional evaluation,and provide beneficial exploration for individualized standardized treatment of proximal fibular tumors based on regional anatomy.