【摘要】 目的总结桡骨远端骨巨细胞瘤切除后,采用吻合血管腓骨小头移植修复骨缺损,重建腕关节的临床效果。方法 2000年3月-2009年3月,收治31例桡骨远端骨巨细胞瘤患者。男14例,女17例;年龄15～42岁,平均37.2岁。病程1个月～2年3个月,平均8个月。腕关节活动范围:背伸5～15°,平均10.7°;掌屈9～21°,平均14.2°;桡侧倾斜0～10°,平均8.6°;尺侧倾斜0～15°,平均7.9°。前臂旋前15～50°,平均28.7°;前臂旋后10～25°,平均16.5°。肿瘤范围为6.5cm3.5cm～8.0cm4.5cm。病理学检查:1级5例,2级17例,3级9例。行肿瘤扩大切除后,采用吻合血管的腓骨小头移植修复桡骨远端缺损,重建腕关节。结果术后切口均Ⅰ期愈合。31例均获随访,随访时间1～9年,平均4.5年。X线片检查示移植腓骨均顺利成活,骨愈合时间12～16周,平均13周。随访期间肿瘤无复发。术后1年,重建腕关节活动范围:背伸20～50°,平均29.0°;掌屈30～50°,平均35.0°;桡侧倾斜10～20°,平均16.5°;尺侧倾斜20～25°,平均23.5°。前臂旋前40～90°,平均68.3°;前臂旋后30～80°,平均59.6°。腕关节及前臂活动范围与术前比较,差异均有统计学意义(P<0.05)。腕关节功能根据Krimmer等评分标准评定,获优17例,良12例,满意2例。结论采用吻合血管腓骨小头移植代替桡骨远端重建腕关节,可较好地保留腕关节功能,是治疗桡骨远端骨巨细胞瘤安全、有效的方法之一。更多还原

【Abstract】 Objective To observe the effectiveness of wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor. Methods Between March 2000 and March 2009, 31 cases of distal radius giant cell tumor were treated with extended resection and vascularized fibular head graft for repairing defects of the distal radius, and reconstructing wrist joint. There were 14 males and 17 females with an average age of 37.2 years (range, 15-42 years). The disease duration ranged from 1 month to 2 years and 3 months with an average of 8 months. The size of tumor was 6.5 cm 3.5 cm-8.0 cm 4.5 cm. The range of motion (ROM) of wrist joint was as follows: extension 5-15° (mean, 10.7°), flexion 9-21° (mean, 14.2 ), radial inclination 0-10 (mean, 8.6 ), and ulnar inclination 0-15° (mean, 7.9°). The ROM of forearm was as follows: pronation 15-50 (mean, 28.7 ) and supination 10-25° (mean, 16.5°). The histopathological examination revealed that there were 5 cases of stage I, 17 of stage II, and 9 of stage III. Results All patients achieved primary healing of incision and were followed up 1-9 years with an average of 4.5 years. The X-ray films showed that bone healing time was 12-16 weeks with an average of 13 weeks. No tumors recurrence was observed. The ROM of wrist joint was as follows at 1 year after operation: extension 20-50 (mean, 29.0 ), flexion 30-50° (mean, 35.0°), radial inclination 10-20° (mean, 16.5°), and ulnar inclination 20-25 (mean, 23.5 ). The ROM of forearm was as follows: pronation 40-90° (mean, 68.3°) and supination 30-80 (mean, 59.6 ). There were significant differences in the ROM between before operation and after operation (P < 0.05). According to the Krimmer et al wrist score, the results were excellent in 17 cases, good in 12, and fair in 2.Conclusion Wrist joint reconstruction with vascularized fibular head graft can restore function of wrist joint. The operation is proved to be safe and effective in treating distal radius giant cell tumor.更多还原