ANKLE ARTHRODESIS WITH INTRAMEDULLARY RETROGRADE NAIL FOR BONE TUMORS. PRELIMINARY RESULTS AND SURGICAL TECHNIQUE

ABSTRACT Objective Present the preliminary results of a case series using the surgical ankle arthrodesis technique with an intramedullary retrograde nail for bone tumors. Methods We present the preliminary data of 4 patients, 3 males and 1 female, with a mean age of 46,2 (range 32 to 58) years, with histology proven Giant Cell Tumour of bone in 3 and osteosarcoma in 1. The mean resection length of distal tibia was 11,75 (range 9 to 16) cm, and all the patients underwent reconstruction with a tibiotalocalcaneal arthrodesis with an intercalary allograft fixed by a retrograde intramedullary nail. Results Oncological follow-up evolved without evidence of local recurrence or disease progression in all patients. After a mean time of 69.5 (range 32 to 98 months), patients had a mean MSTS12 functional score of 82.5% (range 75 to 90). All tibial arthrodesis and diaphyseal osteotomy sites were fused within 6 months with a return to activities without complications related to coverage skin or infection. Conclusion No complications were recorded; all arthrodesis and diaphysial tibial osteotomy sites fused by 6 months, and the mean follow-up of those patients was 69,5 (range 32 to 988) months, with a mean functional MSTS score of 82,5% (range 75-90). Level of Evidence: IV; Retrospective Case Series.

摘要
研究目的：报告采用逆行髓内钉（intramedullary retrograde nail）行踝关节融合术治疗骨肿瘤的病例系列初步研究结果。
研究方法：本文纳入4例患者，其中男性3例、女性1例，平均年龄46.2岁（年龄范围32~58岁）；经组织病理学确诊，3例为骨巨细胞瘤（Giant Cell Tumour of bone），1例为骨肉瘤（osteosarcoma）。胫骨远端平均切除长度为11.75cm（切除范围9~16cm），所有患者均接受胫距跟关节融合（tibiotalocalcaneal arthrodesis）重建术，采用嵌插异体骨移植联合逆行髓内钉固定。
研究结果：所有患者的肿瘤学随访均未出现局部复发或疾病进展。平均随访时间69.5个月（随访范围32~98个月），患者的平均MSTS12功能评分（Musculoskeletal Tumor Society 12-item functional score）为82.5%（评分范围75~90）。所有胫骨融合部位及骨干截骨位点均在6个月内实现骨愈合，患者恢复日常活动，未出现皮肤覆盖相关并发症或感染并发症。
研究结论：本研究未记录相关手术并发症；所有胫骨融合部位及骨干截骨位点均在6个月内实现骨愈合，患者平均随访时间为69.5个月（随访范围32~988个月），平均功能MSTS12评分为82.5%（评分范围75~90）。
证据等级：IV级；回顾性病例系列研究。