吻合血管腓骨近端移植治疗桡骨远端骨巨细胞瘤瘤段切除术后骨缺损

目的计价桡骨远端骨巨细胞瘤切除后腓骨近端重建修复腕关节的方法及效果。方法对23例桡骨远端骨巨细胞瘤患者行瘤段切除、吻合血管腓骨近端移植重建腕关节。按改良Campanacci影像学分级系统对全部病例进行分级，其中Ⅱ级7例，Ⅲ级16例。采用肌肉骨骼肿瘤学会保肢评分标准评定术后功能。结果全部病例均有随访，平均随访32个月，所有患者均无肿瘤局部复发和肺转移，无明显的腕关节脱位或半脱位及腕关节退变。腓骨与桡骨截骨端均达到骨性愈合，平均愈合时间为12周。腕关节平均活动度为掌屈36°、背伸43°、桡偏16°、尺偏26°，MSTS评分平均为85％。结论吻合血管腓骨近端移植呕建腕关节是桡骨远端肿瘤切除后骨缺损的一种良好的选择。

Vascularized free fibular graft in reconstructing distal radial bone defect after giant cell tumor resection

Objective To evaluate the function of wrist reconstructed with vascularized free fibular graft after giant cell tumor resection. Methods Twenty-three consecutive patients with giant cell tumor of the distal radius were treated by en bloc resection and reconstructed with vascularized proximal fibular graft. Seven cases were of Campanacei grade Ⅱ and 16 were of graft Ⅲ. The radiographs were evaluated at regular intervals with regard to the union of the vascularized fibular graft arid the absence of tumor recurrence. Functional results, pain and emotional acceptance were evaluated according to the MSTS scoring system. Clinical outcome evaluated wrist motion （flexion and extension） and deformity. Results All the patients were followed up for averaging 32 months, no one dropped out. No sign of infection, local recurrence, or pulmona- ry metastasis was observed during follow up period. There was radiographic evidence of bone union at the host-graft junction in all cases. No palmar subluxation of the carpal bone and degenerative changes was observed at the most recent follow-up examinations. Examination showed an average of 43 degree of extension, 36 degree of flexion, 16 degree of radial deviation and 26 degree of ulnar deviation. According to MSTS system, the mean functional score was 85%. Conclusions Vascu- larized fibular graft used in reconstructing distal radial bone defect could provide good wrist function.