桡骨远端骨巨细胞瘤切除后三种重建方法的比较

Comparison of three reconstructions after resection of distal radius giant cell tumors

[目的]探讨桡骨远端骨巨细胞瘤切除术后三种重建方法的临床效果。[方法]选取2000年10月~2013年12月间15例桡骨远端骨巨细胞进行瘤段切除,之后根据患者病情分别采取自体腓骨移植重建、同种异体骨移植、人工腕关节置换术三种重建方式,其中接受自体腓骨移植重建术5例,接受同种异体骨移植术6例,接受人工腕关节置换术4例,之后对三组患者进行为期5年的跟踪随访,比较三组患者腕部功能恢复情况,并统计不良症状发生的比例。[结果]MSTS保肢评分系统显示,接受自体腓骨移植重建术患者有4例优、1例良,明显优于接受同种异体骨移植术患者与人工腕关节置换术患者;在腕部功能方面,自体腓骨移植重建术患者腕关节屈伸功能分别为（51.32±9.31）°、（38.13±7.80）°,旋前、旋后功能平均为（71.32±5.63）°、（70.31±4.52）°,明显高于人工腕关节置换术患者、同种异体骨移植术患者（P〈0.05）;而在术后并发症方面,接受自体腓骨移植重建术患者较少。[结论]对于患有桡骨远端骨巨细胞瘤患者,自体腓骨移植重建,同种异体骨移植术,人工腕关节置换术三种重建方式均可以改善患者的病情,安全性较好,无明显不良并发症发生,自体腓骨移植重建术效果更优,可适当临床推广。

[Objective] To compare the effect of three reconstruction methods after resection of the distal radius giant cell tumor. [Methods] Fifteen cases of distal radius bone giant cell tumor between October 2000 and December 2013 were selected,three reconstruction methods were given after resection,which included autologous fibula transplantation（ n = 5）,allograft bone transplantation（ n = 6）,wrist joint arthroplasty（ n = 4）. A 5- year follow- up was carried out to all patients,and the wrist function recovery was observed and compared among three groups. Meanwhile the adverse symptoms were also recorded and statistically analyzed using SPSS 17. 0 software. [Results] According to Musculoskeletal Tumor Society（ MSTS） limb- salvage scoring system,4 excellent and 1 good outcome were achieved in fibula autograft revascularization group,that was obviously better than the results of allogeneic bone grafting group and wrist joint arthroplasty group. In terms of wrist function,the flexion and extension function were（ 51. 32 ± 9. 31）,（ 38. 13 ± 7. 80）,the pronation and supination function were（ 71. 32 ± 5. 63）,（ 70. 31 ± 4. 52） respecitvely in autograft revascularization group,significantly higher than those of the allograft bone transplantation group and wrist joint arthroplasty group（ P〈 0. 05）. In respect of the postoperative complications,less complications were found in fibula autograft revascularization group. [Conclusion] For patients with giant cell tumor of the distal part of the radius,all three methods of autogenous fibular graft reconstruction,allograft bone transplantation,wrist joint arthroplasty can improve the patient＇s condition with good security,and no obvious adverse complications have been found. While fibula autograft revascularization provides better comprehensive effect,which show the consistent results with previous studies. So,we believe it has the potential for further clinical application.