自体腓骨移植治疗桡骨远端肿瘤临床观察

目的 评价采用自体腓骨移植治疗桡骨远端肿瘤的疗效.方法 行桡骨远端瘤段切除,用带或不带血管蒂自体近端腓骨移植,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 术后随访6 ～75个月,平均随访29个月,移植骨愈合良好,平均12周移植骨完全愈合,无明显并发症,肿瘤无复发.功能良好,MSTS功能评分17 ～26分,平均22分.主观满意度均为优良.重建腕关节活动范围掌屈22°～39°,背伸29° ～60°,尺偏18°～40°,桡偏15°～20°.握力是健侧的40％～90％,无腕关节畸形和脱位.结论 取自体腓骨上端移植重建是治疗桡骨远端肿瘤的有效方法,其既彻底切除了骨肿瘤,又保存了患侧上肢,同时也较好地保留了腕关节功能,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.

Clinical Observation of Self Fibular Grafting for Reconstruction of the Distal Radius Tumors

Objective To investigate the effect of self fibular grafting on reconstruction of the distal radius tumors. Methods The wrist joint function was reconstructed by using of vascularized fibular graft or simple autologous vascularized fibular graft after the distal bone tumor resection.All the cases were evaluated by clinical and radiologic examinations. Results The averaged follow-up time was 29 months(6-75 months).The graft healed well in average 12 weeks without obvious complications and recurrence.The wrist function was good.The MSTS score was 17-26 points with an average of 22 points.The subjective satisfaction was excellent.The average movements of the wrist were: 22-39 degrees of flexion,29-60 degrees of extension,18-40 degrees of ulnar deviation,15-20 degrees of radial deviation.Compared with the contralateral side,the average grip strength was accounted for 40%-90%.There were no wrist joint deformities and dislocation. Conclusion The bloc resection of tumor of the distal radius followed by reconstruction with a fibula graft is proved to be an effective method and results in a good functional outcome at long term follow-up evaluation.It both removes the bone tumor completely,and saves the upper limbs,and keeps the wrist joint function effectively.The stability of wrist is achieved by reconstruction of the wrist joint capsule.