特制人工假体置换术治疗桡骨远端骨巨细胞瘤一例报道

桡骨远端骨巨细胞瘤是源于松质骨的溶骨性骨肿瘤,具有潜在恶性,对骨质侵蚀破坏性大,易局部复发。临床上常用肿瘤刮除加植骨术、肿瘤段桡骨切除、游离腓骨头移植或带血管蒂的腓骨头游离移植治疗。也陆续有使用人工腕关节置换治疗桡骨远端骨巨细胞瘤的报道,但因远期效果不甚理想,未广泛应用于临床。笔者使用特制的人工假体置换治疗桡骨远端骨巨细胞瘤1例,随访17个月效果满意,报道如下。     

带血管腓骨移植治疗桡骨远端骨巨细胞瘤

带血管腓骨移植治疗桡骨远端骨巨细胞瘤孔抗美齐伟力卫云涛刘黎军桡骨远端是骨巨细胞瘤的好发部位，由于骨巨细胞瘤是一种潜在恶性的骨肿瘤，局部刮除术后的复发率可达５０％。自１９８５年４月以来，作者采用瘤段切除带血管蒂的游离腓内移植重建腕关节的方法，治疗１１例...     

腓骨近段移植重建桡腕关节治疗桡骨远端骨巨细胞瘤

腓骨近段移植重建桡腕关节治疗桡骨远端骨巨细胞瘤刘志成，李德甫，李天方桡骨远端骨巨细胞瘤治疗比较困难，刮除植骨复发率高，瘤段切除植骨及桡腕关节融合可引起腕关节的功能活动丧失。近２０年来，我们采用瘤段切除，以含腓骨头的胖骨重建桡腕关节，治疗１０例桡骨远端...     

吻合血管的近段腓骨移植重建肩腕关节

目的 探讨带血管蒂的近段腓骨移植重建肩、腕关节炎的疗效。方法 对近端肱骨和桡骨远端骨巨细胞瘤病例彻底切除瘤段骨及周围反应组织,采用带血管蒂的游离近段腓骨移植重建肩关节和腕关节。结果 经术后6个月－2年随访,2例重建肩、腕关节外观和功能恢复良好,肿瘤无复发。结论 带血管蒂近段腓骨移植是治疗肱骨近端和桡骨远端肿瘤切除后骨缺损和重建肩、腕关节的理想方法。     

自体腓骨移植治疗桡骨远端骨巨细胞瘤

目的：探讨白体近端腓骨移植重建在桡骨远端骨巨细胞瘤临床治疗中的应用及效果。方法：对4例桡骨远端骨巨细胞瘤复发（Campanacci Ⅲ级）患者在行桡骨远端瘤段切除的同时,行自体近端腓骨移植重建手术。结果：所有患者随访27～50个月,疼痛症状消失,骨愈合时间5～9个月,平均愈合时间为6．5个月,无移植骨吸收和骨折,腕关节功能握持力为对侧手的55％（40～80％）,背伸活动度可达对侧50％（10～80％）,掌屈达40％（15～70％）,无神经血管损伤症状,恢复正常工作劳动。所有患者均未出现骨巨细胞瘤的复发及肺转移。结论：桡骨远端骨巨细胞瘤经广泛切除后,用自体近端腓骨移植进行保肢治疗,可较好地保留腕关节功能,是一种有效的治疗方法。     

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

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。     

桡骨远端巨细胞瘤切除自体腓骨头移植重建的远期疗效观察

目的 观察桡骨远端巨细胞瘤切除后取自体腓骨头移植重建的远期疗效.方法 对1994年3月至2004年11月31例桡骨远端巨细胞瘤患者行肿瘤大段切除,取自体腓骨上段移植重建.其中男性12例,女性19例;年龄19～48岁,平均31岁.Campanacci分期Ⅲ期24例,Ⅱ期7例.采用吻合血管的腓骨移植6例,其余25例行单纯腓骨移植.对本组患者进行临床及影像学评估,测量患者腕关节活动度、前臂旋前及旋后的活动度,测量患肢的握力.分别以MSTS评分及Mayo腕关节评分系统评价上肢及腕关节功能.结果 随访时间41～169个月,平均86.3个月.吻合血管的腓骨移植骨愈合时间为3～9个月,平均5.1个月.单纯腓骨移植患者骨愈合时间为7～15个月,平均10.3个月.1例单纯腓骨移植患者术后出现骨不愈合.1例患者术后出现肿瘤局部复发,复发率为3.2%.5例患者术后出现桡腕关节脱位.患者术后腕关节活动度为背伸(67.3±9.4)°、掌屈(31.2±5.1)°、桡偏(14.1±4.7)°、尺偏(19.4±3.9)°、前臂旋前(33.8±6.6)°、前臂旋后(15.3±4.0)°.对桡腕关节成型的28例患者进行握力测量为15.5～52.1 kg,平均33.1 kg,占健侧握力的73%.MSTS评分为23～29分,平均25.5分,Mayo腕关节功能评分40～65分,平均56分.结论 取自体腓骨上端移植重建是治疗桡骨远端巨细胞瘤的有效方法,术后患者腕关节功能恢复理想.腕关节囊的重建对于维持桡腕关节的术后稳定具有重要意义.     

吻合血管的游离腓骨移植在桡骨远端骨巨细胞瘤治疗中的应用

目的评价应用显微外科技术,采用肿瘤段桡骨切除,吻合血管保留腓骨小头的自体游离腓骨移植治疗桡骨远端骨巨细胞瘤的疗效。方法行桡骨远端瘤段切除,用带血管的自体近端腓骨移植,修复桡骨缺损并重建腕关节,术后就放射学及功能评价内容进行随访。结果临床应用12例,术后平均随访48个月,均无局部复发,移植骨愈合良好,平均愈合时间为3·5个月。主观满意度为优良,1例最终行关节固定术。重建腕关节活动范围掌屈20°~40°,背伸30°~60°,尺偏20°~40°,桡偏15°~20°。握力是健侧的40%~85%,无腕关节不稳和畸形。腕关节功能评价采用Enneking标准,优2例,良8例,一般2例。结论桡骨远端骨巨细胞瘤经广泛切除后,用自体吻合血管的带腓骨小头游离腓骨移植治疗,既彻底切除了骨肿瘤,又保存了患侧上肢,同时较好地保留腕关节功能,是一种有效的方法。     

吻合膝下外侧动脉的腓骨头移植重建桡腕关节

目的　探索采用吻合膝下外侧动脉的腓骨头移植重建桡腕关节 ,治疗桡骨远端骨缺损的可行性。　方法　对 1999年 10月～ 2 0 0 1年 12月收治的 3例男性桡骨远端骨巨细胞瘤行瘤体切除术 ,其中骨巨细胞瘤 期 2例 , ～ 期 1例。瘤段切除长度为 7～ 8cm。采用吻合膝下外侧动脉的腓骨头移植 ,重建远端桡腕关节。　结果　 3例术后获随访 6～ 18个月 ,4个月内均达骨性愈合 ,肿瘤无复发 ,腕关节功能良好 ,旋前 35～ 70°,旋后 4 5～ 6 0°,掌屈及背伸 35～6 0°。　结论　吻合膝下外侧动脉的腓骨头移植替代缺失的桡骨 ,可根据桡骨肿瘤范围切取其长度 ,是一种损伤小、操作简便、疗效可靠的方法。     

桡骨远端骨巨细胞瘤28例外科治疗

目的：总结我院自1995年至今收治桡骨远端骨巨细胞瘤28例手术治疗及疗效。方法：采用2种不同的手术方式对桡骨远端骨巨细胞瘤进行治疗。结果：刮除植骨、骨水泥充填术后复发率为22％,而游离自体腓骨移植病例无复发。结论：瘤段切除、腓骨近端移植腕关节重建治疗桡骨远端骨巨细胞瘤复发率较传统刮除植骨、骨水泥充填术为低,可以很好的重建腕关节功能、取得满意的临床效果。     

Resection-reconstruction arthroplasty for giant cell tumor of distal radius

Background:

Giant cell tumor (GCT) of the distal radius poses problems for reconstruction after resection. Several reconstructive procedures like vascularized and non-vascularized fibular graft, osteo-articular allograft, ceramic prosthesis and megaprosthesis are in use for substitution of the defect in the distal radius following resection. Most authors advocate wrist arthrodesis following resection of distal radius and non vascularized fibular graft. Here we have analyzed the results of aggressive benign GCTs of the distal radius treated by resection and reconstruction arthroplasty using autogenous non-vascularized fibular graft.

Materials and Methods:

Twenty-four cases of giant cell tumor of the distal radius (mean age 32 years, mean follow-up 6.6 years) treated by en-bloc resection and reconstruction arthroplasty using autogenous non-vascularized ipsilateral fibular graft with a minimum followup of two years have been included in this retrospective study. Nineteen cases were of Campanacci grade III and five were of Grade II recurrence. The mean resected length of the radius was 9.5 (8-12) cm. Routine radiographs and clinical assessments regarding pain, instability, recurrence, hand grip strength and functional status were done at regular intervals and functional results were assessed using (musculoskeletal tumor society) MSTS-87 scoring.

Results:

Early radiological union at host-graft junction was achieved at mean 12.5 weeks, (range 12-14 weeks) and solid incorporation with callus formation was observed in mean 29 weeks (range 28-32 weeks) in all the cases. Satisfactory range of motion (mean 63%, range 52-78%) of the wrist was achieved in 18 cases. Grip strength compared to the contralateral hand was found to be 67% (range 58-74%). Functional results were excellent in six cases (25%), good in 14 cases (58.3%) and four (16.7%) cases had fair results. Soft tissue recurrence was seen in one patient. The most commonly encountered complication was fibulo-carpal subluxation (10 cases, 41.7%).

Conclusion:

Resection of the distal radius and reconstruction arthroplasty with non-vascularized proximal fibular graft is useful in preserving the functional movement and stability of the wrist as well as achieving satisfactory range of movement and grip strength.     

Sauvé-Kapandji手术治疗桡尺远侧关节脱位和关节炎

目的 评价Sauve-Kapandji手术治疗桡尺远侧关节脱位和关节炎的临床疗效.方法 采用Sauve-Kapandji手术治疗桡尺远侧关节脱位和关节炎12例.随访内容包括手术前后腕关节疼痛程度、腕关节活动度、握力以及术后患侧X线片情况.X线片检查观察桡尺远侧关节愈合及测量尺桡骨间距.Mayo腕关节评分法评价手术前、后腕关节功能恢复程度,DASH问卷调查表行手术前、后腕关节功能自我评价.结果 术后随访9～32个月,平均16个月.术前腕关节疼痛值在负重后为[(39.0±17.0),(x)±s,下同],术后疼痛值为(23.0±13.0).尺桡偏活动度术前为(26.0±11.0)°,术后为(41.0±12.0)°;旋前、旋后活动度术前为(84.0±21.0)°,术后为(139.0±33.0)°.握力术前为(12.8±3.6)kg,术后为(24.0±7.4)kg.Mayo评分结果术前为(43.0±13.0),术后为(73.0±16.0),优3例,良4例,中3例,差2例.DASH值术前为(57.0±14.0),术后为(31.0±10.0).X线片检查12例桡尺远侧关节及尺骨移植处全部愈合.结论 Sauve-Kapandji手术治疗桡尺远侧关节脱位和关节炎,疼痛明显减轻,旋转活动度和握力增加,功能明显改善.     

Reconstruction of distal radius by fibula following excision of grade III giant cell tumour: Follow-up of 18 cases

The purpose of this study was to evaluate the long-term results of vascularised fibular graft for reconstruction of the wrist after excision of grade III giant cell tumour in the distal radius. From January 1998 to September 2003, 18 patients with wrist defects due to distal radius grade III giant cell tumour resection were treated with vascularised fibular graft and were followed-up. The limb function was restored to an average 80% of normal function and bone union was achieved within six months in 18 patients with vascularised fibular graft. MSTS score averaged 25.6 and ranged between 21 and 29; Mayo wrist score averaged 56 with a range from 40 to 65. It is appropriate to use the head of the fibula as a substitute for the distal radius. The healing of vascularised fibular graft is very quick and without bone resorption. Thus, in the procedure for reconstruction and limb salvage after bone tumour resection of distal radius, the free vascularised fibular graft with fibular head is an ideal substitute.     

吻合血管的腓骨近端移植修复桡骨远端骨肿瘤切除术后骨缺损

目的 评价吻合血管的腓骨近端移植修复桡骨远端骨肿瘤切除术后骨缺损的方法及治疗效果.方法 对12例桡骨远端骨肿瘤患者行桡骨远端切除,应用吻合血管的腓骨近端移植修复骨缺损并重建桡腕关节.术后对肢体功能及影像学进行评价.结果 12例患者均获随访,时间1～9年.腕关节平均活动度:掌屈30.3°±6.5°,背伸 52.1°±8.7°,尺偏 19.2°±3.6°,桡偏 12.3°±2.1°,旋前 32.1°±4.2°,旋后 21.2°±3.9°.按Enneking标准评价肢体功能:优4例,良6例,一般2例.移植腓骨均在3～6个月达到骨性愈合.5例出现不同程度的下尺桡关节分离,3例出现桡腕关节半脱位.肿瘤无复发.结论 吻合血管的腓骨近端移植是治疗桡骨远端骨肿瘤切除术后骨缺损的有效方法.     

Partial wrist arthrodesis versus arthroplasty for distal radius giant cell tumours

Purpose

The purpose of this study was to evaluate the clinical efficacy of using the proximal fibular graft for partial wrist arthrodesis or arthroplasty after the resection of giant cell tumours of the distal radius.

Methods

Between February 2006 and August 2010, 14 patients (seven males, seven females; average age, 35.7 years) with grade II and III giant cell tumours of the distal radius were treated by tumour resection and autologous proximal fibular grafts to reconstruct the wrist in our hospital. Seven patients each were treated by wrist arthroplasty and partial wrist arthrodesis, and were followed up for 2.2–6.8 years (average, 3.9 years).

Results

All patients achieved primary healing. No tumour recurrence was observed during follow-up in any of the patients. No statistically significant difference in forearm rotation was observed between patients undergoing the two different treatments. However, wrist flexion-extension activities were significantly better and the wrist grip strengths were significantly worse in the arthroplasty group than in the arthrodesis group. The Musculoskeletal Tumour Society score did not significantly differ between the groups.

Conclusions

Overall, joint arthroplasty remains a favourable treatment with regard to the functional outcome for giant cell tumours of the distal radius; however, some of these patients may have a weaker grip strength. In comparison, partial wrist fusion appears to provide a durable and stable wrist with good long-term functional outcome.     

Resection of comminuted ulna head fragments with soft tissue reconstruction when associated with distal radius fractures

Acute management of fractures involving the head and neck of the distal ulna associated with comminuted unstable fractures of the distal radius remains difficult and controversial. Fifteen consecutive such cases treated with combined external and internal fixation together with primary resection of comminuted distal ulna fracture fragments and reconstruction of the periosteal sleeve and triangular fibrocartilaginous complex are reviewed. At an average follow-up of 5.8 years, all patients were assessed for range of motion, strength, pain and function, and radiographic appearance. All had a range of motion postoperatively of at least 85% of the opposite wrist in all planes. Average grip strength was 88.6% of the contralateral wrist. Radiographic evaluation demonstrated no evidence of instability in any plane. There were no cases of subluxation of the distal ulna nor collapse of the ulnar side of the carpus. Those 7 patients studied arthrographically demonstrated an intact "water-tight" ulna-sided soft tissue sling, and all distal radius fractures healed primarily.