自体腓骨移植重建骨巨细胞瘤破坏的桡腕关节

Reconstruction of radiocarpal jiont which was damaged by giant cell tumor with autologous fibular graft

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 efficacy of partial wrist fusion （the fibula and scapholunate fusion） with proximal fibular autologous bone graft after the segment resection of giant cell tumor of the distal radius. Methods Between May 2008 and January 2010, 7 patients with giant cell tumor of the distal radius were treated in our institution, which could be classified into Grade Ⅱ and Grade Ⅲ by Campanacci. There were 4 males and 3 females, with an average age of 32.8 years old （range; 19-45 years）. The disease duration ranged from 1 month to 1 year and 6 months, with an average period of 8 months. 2 patients were treated by partial wrist fusion with free vascularized proximal fibular graft and 5 patients were treated by partial wrist fusion with free non-vascularized proximal fibular graft. Postoperative functional evaluation included wrist motion, forearm rotation and Musculoskeletal Tumor Society （MSTS） scores. Results All patients achieved primary healing of incision, and they were followed up for an average period of 3.1 years （range; 2.2-3.8 years）. The X-ray examination showed all of the transplanted fibulas survived well. The bone healing time of the vascularized fibular graft was 12-16 weeks, and while that of the non-vascularized fibular graft was 18-30 weeks. No tumor recurrence or significant osteoarthritis of the side knee taken from the fibula was observed during the follow-up. The range of motion （ROM） of the wrist joint and forearm was as follows： the mean extension range of motion was 33.8° （range; 28°-40°）, flexion 23.8° （range; 16°-30°）, pronation 72° （range; 55°-80°） and supination 55.4° （range; 38°-75°）. The average grip strength was 76% of that of the healthy side. According to the MSTS scores, the average score was 85.71%. All patients could cope with daily life and work, with good wrist stability and no motion-related pain. Conclusions Wrist joint reconstruction with proximal fibular autologous bone graft by partial wrist fusion can preserve some functions of the wrist joint. This therapeutic method is proved to be safe and effective in treating giant cell tumor of the distal radius.