摘要
目的评价吻合血管或不吻合血管的自体腓骨近端移植重建桡骨远端骨巨细胞瘤切除术后桡腕关节的方法和疗效。方法自2002年2月至2010年2月，对17例桡骨远端骨巨细胞瘤患者行瘤段切除术，之后应用吻合或不吻合血管的自体腓骨近端移植，重建桡腕关节。术后对重建的关节功能及影像学结果进行评价。结果17例均获得随访，时间2．0～5．5年，平均3．6年。3例行腓动脉吻合，3例行膝下外侧动脉吻合。所有切口I期愈合，桡骨平均切除长度7．6cm。所有移植骨均愈合，吻合血管移植的骨愈合时间平均为3．7个月；非吻合血管的为7．9个月。无局部复发及肺转移，无移植腓骨吸收等，1例出现尺腕关节间隙变窄，1例出现腕关节退变。术后2年，重建的腕关节平均活动度：背伸47°、掌屈30°、尺偏23°。、桡偏14°、前臂旋前55°、旋后62°，握力为对侧的40％-80％。MSTS评分平均为87．6％，其中优6例，良8例，中3例，优良率达82．4％。DASH上肢功能调查表平均为3．48分。结论应用自体腓骨近端移植重建桡骨远端骨巨细胞瘤切除术后的桡腕关节，能较好的保留腕关节的功能，是此处关节功能重建有效的方法。吻合血管移植更利于骨愈合，并发症相对较少。
Objective To evaluate the method and curative effect of reconstruction with vascularized or non-vascularized autogenous fibular transplantation of radiocarpal joint after en bloc excision of giant cell tumor of distal radius. Methods Seventeen cases with giant cell tumor of distal radius bone were treated by en bloc resection and reconstruction of wrist joint with vascularized or non-vascularized autogenous fibular transplantation. Postoperative wrist joint function and radiographic outcomes were evaluated. Results Seventeen cases were followed up from 2. 0 to 5.5 years （ average 3.6 years）. Three cases were treated by peroneal artery anastomosis and other 3 cases by inferior lateral genieular artery anastomosis. All cases achieved primary healing of incision and the radial average length that was en bloc excised was 7.6 cm. All of the transplanted fibulas were healed well. The bone healing average time of the vascularized fibular graft was 3, 7 months, while that of the non-vaseularized fibular graft was 7.9 months. No tumor recurrence or lung metastases was observed during the follow-up, but 1 wrist joint was narrowed and another had degeneration of the wrist. After 2 years of surgery, the average range of motion of the wrist joint was as follows： dorsiflexion 47°, flexion 30°, ulnar deviation 23°, radial deviation 14°, pronation 55°, supination 62°. The grip force was from 40% to 80% of the contralateral upper limb. The MSTS score averaged 87.6 % with 6 excellent, eight good and 3 satisfactory results. Disabilities of the Arm, Shoulder, and Hand （DASH） questionnaire score averaged 3.48. Conclusion The method of autogenous fibular transplantation and reconstruction of radiocarpal joint after en bloc excision of giant cell tumor of distal radius can save the wrist joint function in a certain extent. It is an effective method of the wrist joint function reconstruction and beneficial to bone healing with vascularized transplantation which has less complications.
出处
《中华显微外科杂志》
CSCD
北大核心
2013年第6期548-552,共5页
Chinese Journal of Microsurgery
关键词
骨移植
骨重建
骨巨细胞瘤
桡腕关节
腓骨
Bone transplantation
Bone remodeling
Giant cell tumor of bone
Wrist joint
Fibula
