En-bloc切除并半腕关节假体重建治疗桡骨远端骨巨细胞瘤

Half wrist arthroplasty for the reconstruction of bone defects after en-bloc resection of giant cell tumors of the distal radius

目的评价桡骨远端骨巨细胞瘤en-bloc切除并半腕关节假体修复重建的临床疗效。方法2009年1月至2014年1月,对我科桡骨远端骨巨细胞瘤患者11例行en-bloc切除、半腕关节假体修复重建术。其中男6例,女5例,年龄26～51岁,平均39岁。按Campanacci影像学分级系统对骨巨细胞瘤进行分级,其中II级2例,III级9例。病理性骨折1例,复发再次手术5例。对患者进行影像学评价,了解远处转移、局部复发、假体松动和脱位等情况。随访时观察并记录腕关节活动度,并采用Mankin等提出的疗效评定标准进行评价。结果全部病例均有随访,门诊随访9例,电话随访2例,平均随访34.6个月。术后患者主观满意度尚可,无明显腕关节疼痛和肿胀,术后无感染,软组织一期愈合,假体周围未见明显骨溶解、骨质增生。除1例术后15个月软组织内复发外,其余均未发现骨内局部复发和远处转移。术后腕关节平均活动度：掌屈20°、背伸30°、桡偏8°、尺偏10°、旋前25°、旋后40°。Mankin评定结果：优1例、良4例、可5例、差1例。结论桡骨远端骨巨细胞瘤经en-bloc切除并半腕关节假体重建术后复发率低,较大程度保留了腕关节的功能,但其远期效果及并发症尚待进一步观察。

Objective To evaluate the clinical results of half wrist arthroplasty for the reconstruction of bone defects after en-bloc resection of giant cell tumors （ GCT ） of the distal radius. Methods From January 2009 to January 2014, 11 patients with GCT of the distal radius underwent half wrist arthroplasty after en-bloc resection. There were 5 females and 6 males, whose mean age was 39 years old （ range： 26-51 years ）. The Campanacci radiographic grading system was used to evaluate the grade of GCT. Two of the 11 patients were at Grade II and the other 9 patients were at Grade III. There was a cases of pathological fracture and 5 cases of sustained recurrence after tumor curettage and bone grafting. Radiological evaluation was performed, including distant metastasis, local recurrence, prosthetic loosening and prosthetic dislocation. The range of motion of the wrist joint was observed and recorded during the follow-up, and the function was evaluated by using Mankin score. Results All the patients were followed up, including 9 patients in out-patient clinic and 2 patients on the phone. The mean follow-up period was 34.6 months. All the patients were satisfied with the clinical results, with no complications of wrist joint pain, swelling or infection. Primary healing of the soft tissues was achieved. No obvious osteolysis or hyperostosis was found around the prostheses. However, only a patient had relapse in the soft tissue at 15 months after the operation, and no distant metastasis or local recurrence was found in the other patients. The average range of motion of the wrist joint was 20° flexion, 30° dorsiflexion, 8° ulnar deviation and 10° radial deviation. The average rotation degree of the forearm was 25° pronation and 40° supination. According to the Mankin score, there was an excellent case, 4 good cases, 5 passable cases and a poor case. Conclusions The half wrist arthroplasty for the reconstruction of bone defects after en-bloc resection of GCT of the distal radius can not only completely remove the tumors, but also retain the function of the wrist joint. However, its long-term results remain to be observed.