Local wide excision of proximal fibula

Children's bone tumors include primary and secondary bone tumors. Primary bone tumors refer to benign bone tumors, malignant bone tumors and tumor-like lesions originating from bone tissue. Secondary bone tumors refer to other organ malignant tumors. A tumor of bone tissue. Clinically, benign bone tumors and tumor-like lesions are more common. Among malignant bone tumors, osteosarcoma is the most common. In recent years, due to the advancement of surgical techniques, the establishment of surgical system of bone tumor surgery and the extensive application of adjuvant chemotherapy before and after surgery have significantly improved the surgical treatment of bone tumors. The 2-year tumor-free survival rate has increased from 30% to 80%. Moreover, amputation is no longer the first choice for the treatment of malignant bone tumors. Many scholars advocate the use of local extensive or local radical bone tumor resection and limb preservation surgery, that is, surgical removal of tumor lesions, and the use of adjuvant chemotherapy to eliminate the occurrence of Microscopic metastatic lesions. Treatment of diseases: giant cell tumor of bone Indication 1. Invasive benign tumors at the proximal end of the humerus, such as giant cell tumor of bone. 2. Low-grade malignant bone tumor of the proximal humerus, the surgical stage is IA. Preoperative preparation 1. In addition to routine X-ray examination, CT and MRI examinations must be performed to determine the boundaries between bone tumors and normal tissues. 2. Chest X-ray and whole body radionuclide bone scan, except for lung metastasis and bone metastasis. 3. Biopsy clear pathological diagnosis. Surgical procedure Incision and exposure From the center of the back of the thigh, 8cm proximal to the transverse line of the armpit, forward and outward through the humeral head, and then extend to the distal end, stopping at 5cm distal to the plane of the osteotomy. The skin and deep fascia are cut along the direction of the incision to form the anterior and posterior lateral flaps. The latter is released to the posterior midline, and the former reveals the humerus. The common peroneal nerve is released from the anterior medial side of the biceps tendon and is pulled and protected. When the anterior and temporal compartment muscles of the lower leg are to be removed, the distal branch can be sacrificed. Then, the lateral head of the gastrocnemius and the soleus muscle are removed at the proximal end of the humerus, and the axillary blood vessels and their branches are searched for and revealed. If necessary, the gastrocnemius muscle can be cut off at the starting point of the femoral condyle. Then identify and determine the diaphragm, looking for the anterior tibial blood vessel at 2 to 3 cm below its edge and protect it. 2. Excision of the tibia and surrounding muscles The radial artery is pulled back, so that the axillary blood vessels and the posterior tibial blood vessels are away from the tumor. According to the distal plane of the humerus defined by the preoperative X-ray and CT tomography, the distal or muscle tendon junction of the interosseous muscle in the temporal and posterior aspect of the calf was cut. The humerus should generally be cut at a distance of 5 cm from the distal end of the sacral tumor. Then, the starting point of the above muscles was cut, and the patellofemoral collateral ligament of the knee joint, the 2.5 cm femoral biceps tendon at the proximal end of the humerus and the interosseous membrane and patellar tendon were cut. At this point, the normal muscle tissue at the proximal end of the humerus and its surroundings can be removed together. 3. Repair soft tissue defects After the proximal humerus and its surrounding muscles are removed, the tissue should be taken at various locations in the surrounding soft tissue bed for pathological examination to determine whether the tumor is completely removed. Then, the surgical instrument and the surgical gown were replaced, and after the hemostasis was completely stopped, the collateral ligament and the biceps femoris were sewed to the lateral joint capsule with a thick thread at a position where the knee flexed by 30°. The lateral head of the gastrocnemius muscle was cut at its distal end and properly dissociated, and then rotated forward to the inner side to cover the exposed radial artery, posterior tibial artery and lateral aspect of the tibia, and sutured with the soft tissue of the anterior aspect of the tibia. 4. Close the incision After the physiological saline was washed, the incision was sutured in layers, and a vacuum suction tube was placed in the incision.