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目的总结桡骨远端骨巨细胞瘤瘤段切除后,采用自体腓骨近段移植行腕关节部分融合术(腓骨-舟月骨融合)的临床效果。方法 2008年5月至2010年1月,收治7例桡骨远端Ⅱ、Ⅲ级(Campanacci分级)骨巨细胞瘤患者。男4例,女3例;年龄19～45岁,平均32.8岁。病程1-18个月,平均8个月。其中2例采用带血管的腓骨近端移植融合部分腕关节,5例采用不带血管的腓骨近端移植融合部分腕关节。术后功能评价包括腕关节活动度、前臂旋转功能及MSTS评分。结果术后切口均Ⅰ期愈合。7例均获随访,随访时间2.2-3.8年,平均3.1年。X线片检查示移植腓骨均顺利成活,带血管组骨愈合时间为12-16周,不带血管组骨愈合时间18-30周。随访期间肿瘤无复发,取腓骨侧膝关节未见明显骨关节炎表现。腕关节活动范围:背伸28°～40°,平均33.8°;掌屈16°～30°,平均23.8°;前臂旋前55°～80°,平均72°;前臂旋后38°～75°,平均55.4°,平均握力为对侧的76%。MSTS评分平均为85.71%。所有患者腕关节稳定性良好,无活动性疼痛,能够胜任日常生活、工作。结论采用自体腓骨近段移植行腕关节部分融合重建腕关节,能保留一定的腕关节功能,是桡骨远端骨巨细胞瘤安全、有效的治疗方法之一。
Objective To summarize the clinical results of partial fusion of the wrist (Fibula - Scapholunate) by autologous fibular proximal segment after excision of the segment of giant cell tumor of distal radius. Methods From May 2008 to January 2010, 7 patients with giant cell tumor of the second and third grade (Campanacci grade) in the distal radius were treated. 4 males and 3 females; aged 19 to 45 years, an average of 32.8 years old. Duration of 1-18 months, an average of 8 months. In 2 of them, the proximal part of the fibula with blood vessels was used for the fusion of part of the wrist, and the other 5 cases were used for the fusion of some of the wrists with the non-vascular fibular proximal graft. Postoperative functional assessment included wrist mobility, forearm rotation, and MSTS score. Results The incisions healed in the first stage. All the 7 patients were followed up for 2.2-3.8 years with an average of 3.1 years. X-ray examination showed that the graft fibula successfully survived, with vascular group bone healing time is 12-16 weeks, without vascular group bone healing time 18-30 weeks. No tumor recurrence during follow-up, no obvious osteoarthritis of the fibula lateral knee joint performance. Wrist range of motion: dorsal extension 28 ° ~ 40 °, an average of 33.8 °; palmar flexion 16 ° ~ 30 °, an average of 23.8 °; forearm pronation 55 ° ~ 80 °, an average of 72 ° forearm supination 38 ° ~ 75 ° , An average of 55.4 °, the average grip strength of 76% on the contralateral. The MSTS score averaged 85.71%. All patients with good wrist stability, no active pain, capable of daily life, work. Conclusion The autologous fibular proximal segment graft is used to reconstruct the wrist joint, which can retain certain wrist function. It is one of the safe and effective treatments for giant cell tumor of the distal radius.