桡骨远端骨巨细胞瘤的手术治疗

目的比较两种不同手术方法治疗桡骨远端骨巨细胞瘤的临床适应征及远期疗效。方法 2004年5月-2010年1月我院共收治桡骨远端骨巨细胞瘤18例,根据骨巨细胞瘤Campanacci X线分级,对桡骨远端骨巨细胞瘤分别采用瘤骨刮除＋石碳酸灭活＋植骨（A组）或瘤骨完全切除并腓骨移植（B组）两种方法治疗,并给予术后随访。结果临床18例手术均顺利完成,并获得随访,随访13-54个月,平均28个月。A组复发率36.4%（4/11）;腕关节功能综合评价按Enneking标准,优3例、良5例、一般3例,优良率72.72%（8/11）。腕关节屈伸活动平均78°,尺桡偏平均35°。B组术后无复发,腕关节功能评价优1例、良5例、一般1例,优良率85.71%（6/7）;腕关节屈伸活动平均67°,尺桡偏平均30°。结论对Campanacci X线分级达到Ⅲ级及Ⅱ级合并病理骨折的患者采取瘤骨摘除并腓骨移植可显著降低肿瘤复发率并得到较好的腕关节功能恢复。

Surgical treatment of giant cell tumors in distal radius

Objective To compare the indications of giant cell tumor in distal radius for two different surgical procedures and their long-term therapeutic effects.Methods Twenty-one patients with giant cell tumor in distal radius admitted to our hospital from May 2004 to January 2010 were divided into group A and group B.The tumor was graded according to the Campanacci grading system.Patients in group A underwent curettage,adjuvant phenol therapy,and bone grafting.Patients in group B underwent en bloc resection of bone tumor with autologous fibula replacement.The patients were followed up after operation.Results The operation was successful for the 18 patients,all of them were followed up for an average period of 28 months（range 13-54 months）.The tumor recurred in 4 patients in group A with a recurrence rate of 36.4%.According to the Enneking functional evaluation system,excellent,good and fair outcome was achieved respectively in 3,5 and 3 patients with an excellent and good rate was 72.72%.The wrist motion range averaged 78°extension/flexion,35°radial/ulnar deviation.No patient in group B experienced local recurrence.According to the Enneking function evaluation system,excellent,good and fair outcome was achieved in 1,5 and 1 patients respectively with an excellent and good rate was 85.71%.The wrist motion range averaged 67°extension/flexion,30°radial/ulnar deviation.Conclusion The operation must be selected according to the Campanacci grading system.Although the average wrist motion range was lower in group B than in group A,the Enneking function was better in group A than in group B.Local recurrent rate can be decreased by en bloc resection of bone tumor with autologous fibula replacement and achieve a better wrist function when the case is at Campanacci stage Ⅲ or II with morbid fracture.