Tumor resection and reconstruction of the upper end of fibula

Treatment of diseases: bone tumors Indication 1. Malignant tumors of the upper, middle and lower humerus. 2. Other lesions of the tibia, such as bone cysts, poor bone fiber structure. Contraindications 1. Patients with poor physical condition, local acute or chronic skin or soft tissue inflammation. 2. Children should not remove the tibia for bone grafting. Preoperative preparation 1. Same as general orthopedic surgery, such as preparation of skin, heart, lung, liver, kidney function and routine examination of hematuria, bone tumor must be confirmed by pathological biopsy and X-ray examination. 2. For malignant tumors before resection, it is best to first perform chemotherapy or radiotherapy for 1 to 3 courses, so that the tumor is properly controlled, the local mass is reduced, and even after the whole body condition is stabilized, the resection is performed. Surgical procedure 1. Stop the blood band in the middle of the thigh. 2. Posterolateral incision (Henry surgery) Starting from the proximal 4cm of the humeral head, the incision is made downward at the posterior edge of the biceps tendon, and the 1/3 of the humeral head to the humeral shaft is up to the required length. After the shallow and deep fascia is cut, the biceps tendon is cut. After the inner side or find the immediate common peroneal nerve, with the rubber strip pulled forward, after peeling off a part of the long bone fiber attached to the lateral part of the humeral head, the common peroneal nerve is easier to pull forward away from the humerus, if the tibia is simultaneously exposed In the middle part, the gastrocnemius muscle should be peeled off from the tibia and pulled to the posterior side, and then the short iliac muscle should be dissected. When peeling off, care should be taken not to damage the superficial temporal nerve located deep in the longissimus dorsi. Then, the knee lateral collateral ligament and biceps tendon, which are stopped at the head end of the humerus, are cut and pulled proximally, and the joint capsule and ligament of the ankle joint are continuously cut. At this time, the humeral head and the upper 1/3 segment thereof include the tumor. All of them have been detached, and the tibia was cut by a wire saw to select a slash from the tumor at least 5 cm below the tumor. The tumor segment was removed. 3.Mac Lawey Half supine position, 1/3 of the thigh is tied to stop the blood. (1) Skin incision: starting from the proximal end of the axillary fossa 8cm from the humeral head, cut to the humeral head, and then extend the humeral shaft to the distal length to the required length. After the subcutaneous separation, the humerus can be revealed. The posterior medial side of the biceps tendon can reveal the common peroneal nerve. (2) When the anterior and posterior compartment muscles of the calf are removed, the nerve branches at the distal end can be sacrificed. (3) The lower part of the gastrocnemius muscle and the soleus muscle are removed from the tibia to find the axillary blood vessels and their branches. If necessary, the lateral origin of the gastrocnemius muscle from the femur can be cut to determine the diaphragm and at the distal end of the lower edge 2~ The anterior iliac vessels were found at 3 cm, and the axillary vessels and the posterior iliac vessels were loosened and pulled away from the back of the mass. (4) Incision of the muscles of the anterior and posterior intermuscular compartment at the distal end of the junction of the muscle and the tendon and the proximal end of the muscle, cutting the interosseous membrane, the iliac collateral ligament of the knee joint and the proximal end of the sacral muscle The biceps tendon at 2.5 cm removes the proximal intercondylar ligament. After the tumor is removed, the field is washed, and the wound is layered and sutured for drainage. The above two procedures are basically the same, but the Mac Lawey procedure has a slightly wider range.

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