桡、尺骨远端骨巨细胞瘤的手术治疗

目的 观察桡、尺骨远端骨巨细胞瘤手术治疗的效果.方法 选取18例接受手术治疗且术后至少随访24个月的桡骨(15例)或尺骨(3例)远端骨巨细胞瘤患者,其中3例桡骨远端病变患者接受了囊内刮除手术,另12例采用瘤段切除自体腓骨移植重建术;2例尺骨远端病变患者接受单纯瘤段切除术,另1例于切除瘤段后进行腕关节融合.术后随访患者复发情况和关节功能状况.结果 术后平均随访45个月,患者均无局部复发,无感染或周围神经损伤等并发症.2例患者接受自体腓骨移植后出现骨不连,采用自体髂骨块植骨治疗后骨愈合.术后Enneking肢体功能评价平均得分为74%,肢体功能评分与患者性别、肿瘤发生部位和Campanacci骨巨细胞瘤影像学分期无关,与手术方式有关.结论 瘤段切除术治疗桡、尺骨远端骨巨细胞瘤可显著降低肿瘤局部复发率.自体腓骨移植是重建桡腕关节的可行方法.

Surgical treatment of giant cell tumors on distal radius and ulna

Objective To investigate the outcomes of surgical treatment of giant cell tumors on distal radius and ulna. Methods Eighteen patients with giant cell tumors on distal radius (n=15) or distal ulna (n=3) who were followed up for at least 24 months were selected. Three patients with giant cell tumors on distal radius were treated with intralesional excision, and the other 12 were managed with en bloc resection and reconstruction with autogenous fibular head graft. Two patients with giant cell tumors on distal ulna were treated with en bloc resection without reconstruction of osseous defects, and the other one was managed with en bloc resection with wrist joint fusion. Patients were followed up for recurrence and joint function. Results Patients were followed up for an average of 45 months. No patient experienced local recurrence or complications of infection and peripheral nerve injury. Bone nonunion was found in two patients after reconstruction with fibular head graft, and bone union was achieved after autogenous ilium graft. Enneking scoring of limb function after operation was 74%, and limb function scoring was not associated with gender, tumor location and Campanacci giant cell tumor staging, while was associated with surgical approaches. Conclusion En bloc resection for treatment of patients with giant cell tumors on distal radius or ulna can decrease the local recurrence rate. Autogenous fibular head graft can be used for reconstruction of wrist joint.