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

发布时间：2018-02-27 20:48

本文关键词： 桡骨远端骨巨细胞瘤腓骨移植腕关节部分融合术腕关节成形术　出处：《中国矫形外科杂志》2017年17期 　论文类型：期刊论文

【摘要】：[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。
[Abstract]:[objective] to compare and compare the clinical effects of wrist arthroplasty and partial carpal fusion after resection of giant cell tumor of distal radius with proximal fibula graft. [methods] from February 2006 to May 2012, A total of 16 patients with giant cell tumor of the distal radius were treated with autogenous fibula graft after resection of distal radius tumor segment. The patients were divided into two groups: male (8 cases), female (8 cases), age 1955 years (mean 35.40 years). The course of disease ranged from 1 month to 2 years. The main symptoms were pain, swelling and limited movement in 7 patients with partial wrist arthroplasty. All the patients were followed up for 4.00 ~ 10.20 years. In an average of 6.40 years, nonunion between fibula and scaphoid was found in an average of 6.40 years. No recurrence was found in all cases during the follow-up period. Fusion: wrist flexion and extension 55.63 卤6.78 掳, forearm rotation 126.25 卤14.58) 掳, average grip strength 75.14 卤5.74C MSTS = 25.5 卤0.76). Arthroplasty: flexion and extension 72.86 卤15.24) 掳, forearm rotation 140 卤14.72) 掳, flat arm rotation 140 卤14.72) 掳. The average score of MSTS in the contralateral group was 60.62 卤11.83 and the average score of MSTS was 25.86 卤1.46). There was no significant difference in the rotation function of forearm between the two groups. The wrist flexion and extension group was better than the fusion group, while the wrist grip strength fusion group was better than the plastic group, the difference was statistically significant. But there was no significant difference in MSTS score between the two groups. [conclusion] resection of autogenous fibula proximal graft for wrist reconstruction is a good method for the treatment of giant cell tumor of distal radius. Carpal arthroplasty and partial wrist fusion can both retain certain wrist function and are safe and effective reconstruction methods. Individual choice should be made according to the actual situation of the patients.
【作者单位】：同济大学附属第十人民医院;上海交通大学附属第六人民医院南院;上海交通大学附属第六人民医院;
【分类号】：R738

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