异体骨复合人工腕关节重建桡骨远端骨巨细胞瘤切除后骨缺损

Allograft wrist prosthesis composite for the reconstruction of the bone defect after excision of the giant cell tumor of the distal radius

目的:评价桡骨远端骨巨细胞瘤切除后异体骨复合人工腕关节修复重建方法及效果.方法:自2000年6月～2004年6月对8例桡骨远端骨巨细胞瘤患者行瘤段切除、异体骨复合人工腕关节修复重建术,其中男5例,女3例,年龄24～52岁,平均38岁,平均随访33.2个月;按改良Campanacci影像学分级系统对骨巨细胞瘤进行分级,其中Ⅱ级5例,Ⅲ级3例,病理骨折2例;采用肌肉骨骼肿瘤学会保肢评分标准评定术后功能.结果:随访期内所有患者未发现肿瘤局部复发和远处转移;术后无明显异体骨排异反应、感染、骨吸收和骨不连;异体骨与自体骨愈合时间平均5.6个月(4.3～8.2个月);近期人工关节假体无松动、断裂及脱位等并发症;腕关节平均活动度:掌屈38°,背伸45°,桡偏15°,尺偏20°,旋前40°,旋后65°;功能评价结果:优2例,良3例,可2例,差1例.结论:异体骨复合人工腕关节对桡骨远端肿瘤切除后骨缺损的重建是一良好的选择,远期效果尚待进一步观察.

Objective:To evaluate the effects of allograft wrist prosthesis composite for repairing the bone defect and reconstructing the joint function after en bloc resection of the giant cell tumor of the distal radius.Method:Allograft wrist prosthesis composite for the reconstruction of the bone defect after excision of the giant cell tumor of the distal radius was performed in eight patients from June 2000 to June 2004.There were five male and three female patients between 24 and 52 years old(mean,38 years old)at the time of surgery.These patients were followed up for a mean of 33.2 months.The modified campanacci radiographic grading system was used to evaluate the grade of giant cell tumor.Five of eight patients were at Grade Ⅱ and three patients were at Grade Ⅲ.There were two pathological fracture patients at Grade Ⅲ.The functional results were evaluated by using the Musculoskeletal Tumor Society’s rating score of limb salvage.Result:There were no local recurrences and pulmonary metastases in all patients during the follow-up period.No complications such as immune rejection,infection,absorption,nonunion,or fracture were seen.The mean healing time of the osteotomy site was 5.6 months(range from 4.3 to 8.2 months).None of the patients had any signs of wrist prosthesis failure such as loosening,breakage and dislocation.The average ROM of the wrist was 38° flexion,45° dorsiflexion,15° radial deviation,20° ulna deviation,40° pronation,and 65° supination.The functional results were classified as being excellent in two cases,being good in three cases,being fair in two cases,and being poor in one case.Conclusion:This clinical study suggests that allograft wrist prosthesis composite is a useful and reliable procedure in the treatment of the giant cell tumor of the distal radius,although the follow-up period is not so long.Further observation will be expected.