吻合血管的腓骨近端移植修复桡骨远端骨肿瘤切除术后骨缺损

Vascularized proximal fibular graft in repairing radius bone defect after tumor resection

目的评价吻合血管的腓骨近端移植修复桡骨远端骨肿瘤切除术后骨缺损的方法及治疗效果。方法对12例桡骨远端骨肿瘤患者行桡骨远端切除,应用吻合血管的腓骨近端移植修复骨缺损并重建桡腕关节。术后对肢体功能及影像学进行评价。结果 12例患者均获随访,时间1～9年。腕关节平均活动度:掌屈30.3°±6.5°,背伸52.1°±8.7°,尺偏19.2°±3.6°,桡偏12.3°±2.1°,旋前32.1°±4.2°,旋后21.2°±3.9°。按Enneking标准评价肢体功能:优4例,良6例,一般2例。移植腓骨均在3～6个月达到骨性愈合。5例出现不同程度的下尺桡关节分离,3例出现桡腕关节半脱位。肿瘤无复发。结论吻合血管的腓骨近端移植是治疗桡骨远端骨肿瘤切除术后骨缺损的有效方法。

Objective To evaluate the method and efficacy of vascularized proximal fibular graft in repairing distal radius bone defect and reconstructing radiocarpal joint after tumor resection.Methods 12 patients with bone tumor in distal radius were treated by en bloc resection and reconstructed with vascularized proximal fibular graft.After surgery,follow-up was made for the radiographical and functional evaluation.Results The follow-up lasted 1~9 years.The average movements of the wrist were： 30.3°±6.5°of flexion,52.1°±8.7°of extention,19.2°±3.6°of unlar deviation,12.3°±2.1°of radial deviation,32.1°±4.2°of pronation,21.2°±3.9°of supination.According to Enneking′s system,4 cases were rated as excellent,6 good,and 2 fair.The bone union time was 3 months to 6 months.5 cases appeared distal radiounlar joint separation.3 cases developed an wrist dislocation.No tumor recurred.Conclusions Vascularized proximal fibular graft in reconstructing distal radius bone defect after tumor resection is proved to be an effective method.