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目的评价桡骨远端骨巨细胞瘤瘤段切除后人工全腕关节重建的方法和效果。方法 2005年3月至2009年4月,采用全腕关节置换方法治疗4例桡骨远端骨臣细胞瘤患者。其中男2例,女2例;年龄23～66岁。4例中例为首诊,1例为肿瘤刮除植骨后复发,1例为肿瘤刮除骨水泥充填后复发。于包膜外切除瘤段,植入定制人工全腕关节,修复桡骨远端骨缺损并重建腕关节。术后就放射学及功能评价进行随访。结果 4例均获得随访,随访时间9-45个月(平均25.5个月),随访期内末发现肿瘤局部复发和远处转移;无假体排斥反应及感染出现;近期人工关节假体无松动、断裂及脱位等并发症,腕关节平均活动度:掌屈48。,背伸35°,尺偏36°,桡偏15°;前臂旋转平均值:旋前38°,旋后55°,腕关节功能良好。结论人工全腕关节置换治疗桡骨远端骨巨细胞瘤,在彻底切除肿瘤的同时较大程度保留了腕关节功能,是一种治疗桡骨远端骨臣细胞瘤的良好方法,特别是应用于恶性骨巨细胞瘤患者,较其他方法复发率更低,术后功能更理想,但其远期疗效及并发症尚有待进一步观察。
Objective To evaluate the method and effect of artificial total wrist reconstruction after resection of giant cell tumor of radius in the distal radius. Methods From March 2005 to April 2009, four patients with distal radius of the bone were treated by total wrist arthroplasty. Including 2 males and 2 females; aged 23 to 66 years. Among the 4 cases, the first case was diagnosed, the other was recurrence after curettage and bone graft in one case, and recurrence after tumor curettage and bone filling in one case. In the excision of extracapsular tumor segment, implantation of artificial total artificial wrist, repair of distal radius defect and reconstruction of the wrist. Radiological and functional evaluation was followed up. Results All the 4 cases were followed up for 9-45 months (mean 25.5 months). Local recurrence and distant metastasis were found at the end of follow-up. There was no rejection and infection of prosthesis. No artificial prosthesis , Fracture and dislocation and other complications, wrist average activity: Palms 48. , 35 ° dorsiflexion, 36 ° ulnar deviation and 15 ° radial deviation. The average forearm rotation value is 38 ° before rotation and 55 ° after rotation, and the wrist joint function is good. CONCLUSION: Artificial total wrist arthroplasty for the treatment of giant cell tumor of the distal radius is a good method for the treatment of the distal radius of the tumor, especially in malignant Giant cell tumor of bone in patients with lower recurrence rate than other methods, postoperative function is more ideal, but its long-term efficacy and complications remains to be further observed.