上肢骨肿瘤切除后的自体骨移植重建

RECONSTRUCTION OF BONE DEFECTS WITH AUTOGRAFT AFTER RESECTION OF UPPER EXTREMITY BONE TUMOR

目的探讨应用自体骨移植对上肢骨肿瘤切除后的骨缺损修复重建的效果。方法1998年8月～2004年3月，收治上肢骨肿瘤切除后的骨缺损16例。男8例，女8例。年龄7～45岁。经病理确诊，肱骨近端尤文肉瘤和骨肉瘤各1例；肱骨远端尤文肉瘤2例；桡骨远端骨巨细胞瘤8例，高分化软骨肉瘤2例，恶性纤维组织细胞瘤和骨肉瘤各1例。2例肱骨近端肿瘤行自体锁骨代肱骨；2例肱骨远端肿瘤行自体腓骨代肱骨；12例桡骨远端肿瘤中，1例行自体髂骨移植，11例行自体腓骨代桡骨进行重建。采用MSTS系统进行术后功能评价。结果2例肱骨近端自体锁骨移植患者分别随访36个月和12个月，术后保持部分肩关节前屈和后伸功能，但外展功能丧失；MSTS评分分别为23分和22分。2例肱骨远端自体腓骨移植患者分别随访4个月和6个月，肘关节功能良好，移植骨连接处已经出现骨愈合；MSTS功能评分分别为24分和19分。12例桡骨远端自体骨移植患者中11例随访6～75个月，功能良好，无明显并发症；1例髂骨植骨的桡骨远端骨巨细胞瘤术后3个月移植骨完全愈合，至今随访75个月，肿瘤无复发。MSTS功能评分18~27分，平均22．6分。结论自体骨移植在上肢骨肿瘤切除后骨缺损的重建，尤其是儿童的骨缺损重建中，是一种较好的方法。

Objective To discuss the reconstructive method of the bone defect after resection of the upper extremity bone tumor and to assess the outcome of the autograft to reconstruct the bone defect after the bone tumor resection. Methods From August 1998 to March 2004,16 patients aged 7-45 years suffering from bone tumor of the upper extremity were treated with the wide resection of the bone tumor and the reconstruction of the bone defect by the autograft. The following diagnoses were confirmed by pathoiogical examination：Ewing＇s sarcoma and osteosarcoma of the proximal humerus in 1 patient each; Ewing＇s sarcoma of the dista; humerus in 2 patients; giant ceil tumor in 8 patients, high-grade chondrosarcoma in 2, maiignant fibrohistiocytoma in 1 ; and osteosarcoma in 1 of the distal radius. Substitution of the proximal humerus with the ciavicie was performed in 2 patients, and the distal humerus with the fibula in other 2 patients. Of the 12 patients with tumor in the distal radius, 1 was reconstructed with autograft of the iliac bone and 11 with autograft with the fibula. The functional outcome was evaluated by the MSTS score. Results The follow-up for 36 and 12 months respectiveiy reveaied that in the 2 patients undergoing the autograft with the clavicle in the proximal humerus, good shouider functions of fiexion and extension were obtained aithough the function of abduction was poor, with the MSTS scores of 23 and 22 respectiveiy. In the 2 patients undergoing the autograft with the fibular in the dista[ humerus, good elbow function and bone union were observed according to the foiiow-up for 3 and 4 months respectively, with the MSTS scores of 24 and 19 respectiveiy. Of the 12 patients undergoing the autograft in the distal radius, 11 had an exceiient or good function with no compiication, with the average MSTS score of 22.6 （ranging from 18 to 27）, according to the foiiow-up for 6-75 months; oniy 1 had no bone union 10 months after operation and lost the foiiow-up afterwards. Conclusion Reconstruction of the bone defect with the autograft after the wide resection of the upper extremity bone tumor is an ideal and reiiable method for some suitabie patients, especiaiiy for some children.