腓骨近端移植治疗桡骨远端骨巨细胞瘤:关节融合与成形的比较

Wrist partial arthrodesis versus arthroplasty for the treatment of distal radius giant cell tumor with proximal fibular graft

[目的]回顾性比较研究桡骨远端骨巨细胞瘤切除后采用腓骨近端移植行腕关节成形术和腕关节部分融合术的临床疗效。[方法]2006年2月~2012年5月,采用桡骨远端瘤段切除自体腓骨移植重建腕关节方法治疗16例桡骨远端Ⅱ、Ⅲ级(Campanacci分级)骨巨细胞瘤患者。男8例,女8例,年龄19~55岁,平均35.40岁。病程1个月~2年,主要症状为关节疼痛、肿胀及活动受限。9例行部分腕关节融合术,7例行腕关节成形术。[结果]术后切口均一期愈合。所有患者均获随访,随访时间4.00~10.20年,平均6.40年。1例融合病例出现腓骨-舟月骨界面不愈合,排除出该研究。随访期间所有病例肿瘤无复发。融合术病例:腕关节屈伸(55.63±6.78)°,前臂旋转(126.25±14.58)°,平均握力为对侧的(75.14±5.74)%,MSTS评分平均为(25.5±0.76)分。成形术病例:屈伸(72.86±15.24)°;前臂旋转(140±14.72)°,平均握力为对侧的(60.62±11.83)%,MSTS评分平均为(25.86±1.46)分。前臂旋转功能方面两组差异无统计学意义;腕关节屈伸活动成形组优于融合组,而手腕握力融合组优于成形组,差异有统计学意义;但两组MSTS评分差异无统计学意义。[结论]瘤段切除自体腓骨近段移植重建腕关节是治疗桡骨远端骨巨细胞瘤的良好方法,腕关节成形术和腕关节部分融合术都能保留一定的腕关节功能,都是安全、有效的重建方式。应根据患者的实际情况作出个性化选择。

[Objective] To compare the clinical outcomes of the wrist partial arthrodesis versus arthroplasty for the treatment of distal radius giant cell tumor with proximal fibular graft. [Method] Between February 2006 and May 2012, 16 grade Ⅱ, Ⅲ giant cell tumor of distal cases were treated with tumor resection and autologous proximal fibular graft transplantation to reconstruct the wrist in our hospital, including 8 males and 8 females with an average age of 35.4 years （range, 19-55 years） . The course of disease ranged from 1 month to 2 years, and the main symptoms were joint pain, swelling, and limitation of activi- ty. Of them, 9 patients received partial wrist arthrodesis, and the remaining 7 patients were treated with wrist arthroplasty. [Result ] All patients were followed up for 4.0-10.2 years with an average of 6.4 years. Non-union at interface of fibula-scapho-luMate was found in 1 case who was excluded from functional assessment in this study. All incision achieved primary healing, and no tumors recurrence was observed during follow-up. In arthrodosis group, the average range of motion of the wrist at total flex- ion-extension and at total pronation-supination were 55.63±6.78 degrees, 126.25± 14.58 degrees respectively. The average grip strength was accounted for （75.14±5.74） % compared with the contralateral side, and MSTS score averaged 25.5±0.76. Meanwhile, those parameters in arthroplasty group were 72.86± 15.24 degrees, 140± 14.72 degrees, （60.62± 11.83） %, as well as 25.86±1.46, respectively. The difference of forearm rotation was not statistically significant. The wrist flexion-extension activities was better in arthroplasty group than that in arthrodesis group, and the wrist grip strength was found less than that in arthrodesis group, the differences were statistically significant （P〈0.05） . However, MSTS score was not significantly different between two groups （P〉0.05） . [Conclusion] After tumor resection and autologous fibular graft transplantation for treatmenl of distal radius giant cell tumor, partial arthrodesis and arthroplasty both can retain some wrist function, and are proved to be safe, effective proeedure of reconstruction. Personalized selection should be applied based on the actual situation of the patient.