桡骨远端巨细胞瘤切除自体腓骨头移植重建的远期疗效观察

Long-term result of fibula grafting for reconstruction of the distal radius after giant cell tumor excision

目的观察桡骨远端巨细胞瘤切除后取自体腓骨头移植重建的远期疗效。方法对1994年3月至2004年11月31例桡骨远端巨细胞瘤患者行肿瘤大段切除，取自体腓骨上段移植重建。其中男性12例，女性19例；年龄19—48岁，平均31岁。Campanacci分期Ⅲ期24例，Ⅱ期7例。采用吻合血管的腓骨移植6例，其余25例行单纯腓骨移植。对本组患者进行临床及影像学评估，测量患者腕关节活动度、前臂旋前及旋后的活动度，测量患肢的握力。分别以MSTS评分及Mayo腕关节评分系统评价上肢及腕关节功能。结果随访时间41～169个月，平均86．3个月。吻合血管的腓骨移植骨愈合时间为3—9个月，平均5．1个月。单纯腓骨移植患者骨愈合时间为7～15个月，平均10．3个月。1例单纯腓骨移植患者术后出现骨不愈合。1例患者术后出现肿瘤局部复发，复发率为3．2％。5例患者术后出现桡腕关节脱位。患者术后腕关节活动度为背伸（67．3±9．4）°、掌屈（31．2±5．1）°、桡偏（14．1±4．7）°、尺偏（19．4±3．9）°、前臂旋前（33．8±6．6）°、前臂旋后（15．3±4．0）°。对桡腕关节成型的28例患者进行握力测量为15．5～52．1kg，平均33．1kg，占健侧握力的73％。MSTS评分为23—29分，平均25．5分，Mayo腕关节功能评分40—65分，平均56分。结论取自体腓骨上端移植重建是治疗桡骨远端巨细胞瘤的有效方法，术后患者腕关节功能恢复理想。腕关节囊的重建对于维持桡腕关节的术后稳定具有重要意义。

Objective To observe the long-term result of fibula grafting for reconstruction of the distal radius after giant cell tumor excision. Methods From March 1994 to November 2004,31 cases of fibula grafting for reconstruction of the distal radius for giant cell tumors performed were analysed. There were 12 males and 19 females. The patients were from 19 to 48 years old, and the mean age was 31 years. Twenty-four patients had Campanaeci grade 3 lesions, and 7 patients had Campanacci grade 2 lesions. There were 6 cases of vascularized fibular grafting and 25 cases of non-vascularized fibular grafting. All cases were evaluated by clinical and radiologic examinations; the movement of the wrist and the grip strength was measured; the MSTS score and Mayo Wrist scores were calculated. Results Clinical follow-up time after reconstruction averaged 86. 3 months, range from 41 to 169 months. The mean time for bone union at the host-graft junctions was 5. 1 months range from 3 to 9 months in vascularized group and 10. 3 months range from 7 to 15 months in non-vascularized group. One patient who had non-vascularized fibula grafting developed non-union at the host-graft junction, and one patient had local recurrence （3.2%）. Five patients developed an wrist dislocation after surgery. The average movements of the wrist were ： 67. 3± 9. 4 degrees of extension, 31.2 ± 5. 1 degrees of flexion, 14. 1 ± 4. 7 degrees of radial deviation, 19. 4 ± 3.9 degrees of ulnar deviation, 33.8 ± 6. 6 degrees of pronation, 15.3 ± 4. 0 degrees of supination. Average grip strength was 33. 1 kg range from 15. 5 to 52. 1 kg. Compared with the contralateral side, there were accounted for 73%. MSTS score averaged 25.5 from 23 to 29, Mayo wrist score averaged 56 from 40 to 65. Conclusions En bloc resection of giant cell tumor of the distal radius followed by reconstruction with a fibula graft is proved to be an effective method and results in a good functional outcome at long term follow-up evaluation.The stability of wrist is achieved by reconstruction of the capsule.