非血管化自体腓骨移植重建术治疗桡骨远端骨巨细胞瘤的临床疗效

Clinical study of non-vascularized fibular autograft in the treatment of giant cell tumor of distal radius

目的:评价非血管化自体腓骨移植重建术治疗桡骨远端骨巨细胞瘤的临床疗效。方法:选取我院2013年1月至2016年1月收治的行手术治疗的10例桡骨远端骨巨细胞瘤患者,纳入患者均为Ⅲ级,年龄23~35岁,平均年龄(29. 2±4. 1)岁,左侧4例,右侧6例,原发骨巨细胞瘤患者8例,复发患者2例,平均随访时间为(39. 1±10. 1)个月,分析患者手术相关指标、腕关节功能、影像学检查结果。结果:MSTS平均评分为26. 2±1. 8(范围:23~29),DASH平均评分11. 0±3. 1 (范围:6. 4~15. 4)。桡侧屈平均度数(12. 8±2. 5)°(范围:10°~17°),尺侧屈平均度数(14. 7±4. 0)°(范围:10°~21°),屈曲平均度数(24. 8±4. 7)°(范围:15°~31°)、伸展平均度数(35. 1±3. 8)°(范围:29°~42°)、内旋平均度数(46. 9±10. 8)°(范围:26°~63°)、外旋角度平均度数(38. 7±6. 2)°(范围:33°~53°)。前臂旋前为(44. 3±6. 4)°,旋后为(46. 3±7. 1)°。术后(6. 8±3. 5)个月时,尺腓关节间隙为(2. 6±1. 6) mm,腓骨尺偏角为(28. 8±4. 2)°,腓骨点高(9. 4±2. 5) mm,尺骨变量为(-1. 2±1. 9) mm,侧位片腓尺夹角为(4. 9±5. 0)°。握力百分比平均为(63. 5±9. 1)%(范围:53%~81%)。腕关节功能优良率为80. 0%。所有患者X线显示均有不同程度的退行性关节炎表现,其中1级患者有5例,2级患者有4例,3级患者1例。10例患者还观察到不同程度的骨吸收,腕关节半脱位1例。结论:瘤段切除联合非血管腓骨移植腕关节重建术可以成为治疗桡骨远端骨巨细胞瘤常规术式,可在临床大力推广。

Objective：To evaluate the clinical efficacy of non-vascularized fibular grafting in the treatment of giant cell tumor of the distal radius.Methods：Ten patients with giant cell tumor of distal radius of surgical treated in our hospital from January 2013 to January 2016 were enrolled in this study.All patients were grade Ⅲ,aged from 23 to 35 years,mean age （29.2±4.1） years old,4 cases on the left and 6 cases on the right,8 cases of primary giant cell tumor of bone and 2 cases of recurrence.The average follow-up time was （39.1±10.1） months.Patient＇s surgery related indicators,wrist function,imaging findings were analyzed.Results：The average MSTS score was 26.2±1.8 （range：23～29） and DASH average score was 11.0±3.1（range：6.4～15.4）.The average degree of radial flexion was （12.8±2.5）° （range：10°～17°）,the average number of ulnar flexion was （14.7±4.0）°（range：10°～21°） and mean flexion was （24.8±4.7）°（range：15°～31°）,average degree of extension （35.1±3.8）° （range：29°～42°）,average degree of pronation （46.9±10.8）°（range：26°~63°）.The average degree of external rotation angle （38.7±6.2）°（range：33°～53°）.Forearm pronation is （44.3±6.4）°,after rotation （46.3±7.1）°,after operation （6.8±3.5） months,the space between the ulnar and fibular joint was （2.6±1.6） mm,the fibula ulnar deviation angle was （28.8±4.2）°,the fibula point was high （9.4±2.5） mm,the ulna variable was （-1.2±1.9） mm,and the lateral piers were （4.9±5）°.The average grip strength percentage was （63.5±9.1）%（range：53%～81%）.Excellent rate of wrist function was 80.0%.All patients showed varying degrees of degenerative arthritis manifestations of X-ray,including 5 patients in grade 1,4 patients in grade 2,1 patient in grade 3.Ten patients also observed varying degrees of bone resorption.A case of wrist subluxation.Conclusion：Tumor resection combined with non-vascular fibular grafting can be the most common method for the treatment of giant cell tumor of distal radius in the wrist.It is clinically promoted.