桡骨远端骨肿瘤切除后腕关节功能重建方法的探讨  

Functional reconstruction of the wrist joint following resection of bone tumor over the distal end of the radius.

作　　者：蒋电明[1] 安洪[1] 谭富生[1] 向国元[1] 曾建成[2] 裴福兴[2] 胡云洲[2] 屠重琪[2] 黄富国[2] 杨志明[2] 

机构地区：[1]四川大学华西医院骨科,成都610041 [2]重庆医科大学附一院骨科

出　　处：《中国骨肿瘤骨病》2002年第2期95-98,共4页Chinse Journal Of Bone Tumor And Bone Disease

摘　　要：目的 探讨桡骨远端骨肿瘤切除后,腕关节功能重建方法及其远期疗效。方法 回顾性分析桡骨远端骨肿瘤64例(骨巨细胞瘤51例,软骨肉瘤7例,恶性纤维组织细胞瘤6例),均行瘤段广泛切除。采用不同方式重建桡腕关节,其中带血管蒂腓骨上段移植27例,游离腓骨上段移植23例,人工腕关节置换8例,同种异体桡骨下端移植6例。对64例患者的疼痛情况、功能、腕关节活动度、X线片及肿瘤复发情况等指标进行比较研究,平均随访10年3个月。结果 51例骨巨细胞瘤有3例2-3年后局部软组织复发,再次行手术切除软组织肿块;7例软骨肉瘤有4例无瘤存活,2例局部复发行截肢术,1例死于肺转移;6例恶性纤维组织细胞瘤有2例无瘤存活(分别为术后8年和19年),4例术后1-5年肺转移死亡。4种重建方式中,腓骨上段移植组功能优良率达93％以上(带血管蒂腓骨上段移植组骨愈合较快,平均3.2个月;游离腓骨上段移植组移植骨平均愈合时间为4.9个月,但两组间远期腕关节功能恢复及优良率差异无显著性;人工腕关节组腕关节各项活动均较好,但手的握力不如腓骨上段移植组,优良率为87.3％;同种异体桡骨下端移植组功能恢复较差。结论 桡骨远端破坏较广的侵袭性骨肿瘤及其他恶性骨肿瘤,行瘤段广泛切除后,可根据肿瘤性质及骨缺损情况,选用不同方法重建腕关节功能。Objective To evaluate the methods of functional reconstruction of the wrist joint after excision of bone tumor over the distal end of the radius. Methods Between 1976 and 1999, functional reconstruction of the wrist joint were performed after wide resection of bone tumors over the distal end of the radius. The operations were done with vascularized fibular graft in 27 patients, non - vascularized fibular graft in 23, prosthetic replacement in 8, allograft replacement in 6.The tumor lesions consisted of giant cell tumors in 51 cases,chondrosarcoma in 7,malignant fibrous histiocytoma in 6. All patients were followed - up for a minimum of 16 months(average, 123.6 months; range, 16 to 291 months) . Results At the time of follow - up,3 patients with giant - cell tumor underwent resection of recurrent lesion in the soft tissue.2 patients with chondrosarcoma had amputation due to recurrence of the tumor,one died due to pulmonary metastasis. Four patients with malignant fibrous histiocytoma died of pulmonary metastasis within 5 years after operation. 93 % of the 50 patients undergone surgery with fibular graft had excellent or good results. The average healing time in vascularized fibular graft was 3.2 months and shorter than that in non - vascularized fibular graft(4.9 months);however, there was no significant difference in long term results.The 8 patients undergone prosthetic replacement had excellent or good uesults 7 and an excellent range of wrist motion,but their grip strength of hand was much weaker than the those who had fibular graft. The 6 patients treated with allograft replacement of the distal radius had poor wrist function. Conclusion Vascularized or non - vascularized fibular graft is a good option for reconstruction of the distal aspect of the radius after excision of a low - grade malignant bone tumor or a recurrent or locally invasive lesion. Prosthetic replacement of wrist is another option for the elderly or the patients with a high - grade malignant bone tumor of the distal radius because of its shor

关 键 词：骨肿瘤 桡骨远端 外科手术 重建 

分 类 号：R738.1[医药卫生—肿瘤]