带血管蒂腓骨瓣移植重建CampanacciⅢ级桡骨远端骨巨细胞瘤切除术后桡腕关节的远期疗效

Long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci gradeⅢgiant cell tumor

目的总结CampanacciⅢ级桡骨远端骨巨细胞瘤(giant cell tumor,GCT)瘤段切除后,采用带血管蒂自体腓骨瓣移植重建桡腕关节的远期疗效。方法2010年12月-2014年12月,收治10例CampanacciⅢ级桡骨远端GCT患者。其中男6例,女4例;年龄22~65岁,平均39.9岁。病程1.5~6.0个月,平均2.6个月。4例合并病理性骨折。肿瘤切除后桡骨远端骨缺损长度为6.0~12.5 cm,平均8.4 cm。采用自体腓骨瓣移植重建桡腕关节,6例吻合膝下外侧血管,4例吻合膝下外侧血管+腓血管双套血管蒂。结果术后切口均Ⅰ期愈合。患者均获随访,随访时间4.4~8.3年,平均6.0年。随访期间肿瘤无复发。末次随访时,腕关节活动范围:背伸25~85°,平均55.0°;掌屈15~40°,平均26.5°;桡偏5~25°,平均12.0°;尺偏10~30°,平均19.6°;前臂旋前5~90°,平均50.5°;旋后20~90°,平均66.5°。患侧握力达健侧60%~85%,平均75%。美国骨与软组织肿瘤协会(MSTS)评分为75%~90%,平均82.7%。X线片复查示移植腓骨瓣均愈合,愈合时间12~16周,平均14.1周;9例出现影像学并发症。结论CampanacciⅢ级桡骨远端GCT切除后,采用带血管蒂腓骨瓣移植重建桡腕关节,能够有效保留腕关节功能。

Objective To evaluate the long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor(GCT)of distal radius.Methods Between December 2010 and December 2014,10 patients with Campanacci grade Ⅲ GCT of distal radius were treated with en bloc excision and inradiocarpal joint reconstruction using vascularized fibula flap.They were 6 males and 4 females,with an average age of 39.9 years(range,22-65 years).The disease duration was 1.5-6.0 months(mean,2.6 months).The length of distal radius defect was 6.0-12.5 cm(mean,8.4 cm)after en bloc excision of GCT.Vascularized fibula flap with inferior lateral genicular vessels were performed in 6 patients and with inferior lateral genicular vessels and peroneal vessels in4 cases.Results All incisions healed by first intention.All patients were followed up 4.4-8.3 years(mean,6.0 years).There was no tumor recurrence during follow-up.At last follow-up,the mean ranges of motion of wrist joint were 55.0°(range,25-85°)in extension,26.5°(range,15-40°)in flexion,12.0°(range,5-25°)in radial deviation,19.6°(range,10-30°)in ulnar deviation,50.5°(range,5-90°)in pronation,and 66.5°(range,20-90°)in supination.The mean grip strength of effected wrist was 75%(range,60%-85%)of the healthy wrist.The mean Musculoskeletal Tumor Society(MSTS)score was82.7%(range,75%-90%).X-ray films showed that the fibula flap healed at 12-16 weeks after operation(mean,14.1 weeks)and there were 9 cases of radiological complications.Conclusion For Campanacci grade Ⅲ GCT of distal radius,application of the vascularized fibula flap in radiocarpal joint reconstruction after en bloc excision of GCT can obtain good wrist function.