同种异体骨关节移植并钢板置入内固定治疗桡骨远端骨巨细胞瘤9例  

Allogenic osteoarticular allograft combined with plate implantation for the treatment of giant cell tumor of the distal radius in 9 cases

作　　者：刘跃辉[1] 屠重棋[1] 张开伟[1] 周勇[1] 张帅[1] 段宏[1] 

机构地区：[1]四川大学华西医院骨科,四川省成都市610041

出　　处：《中国组织工程研究与临床康复》2009年第43期8573-8577,共5页Journal of Clinical Rehabilitative Tissue Engineering Research

摘　　要：背景:桡骨远端骨巨细胞瘤瘤段切除后重建方法较多,但是各种重建方法术后腕关节功能均较差。有关大段同种异体骨重建桡骨远端骨关节缺失国内报道少。目的:观察应用瘤段切除、同种异体骨关节移植治疗桡骨远端骨巨细胞瘤的效果。设计、时间及地点:回顾性病例分析,病例来自2003-07/2008-01四川大学华西医院骨科。对象:按纳入标准选择四川大学华西医院骨科收治的桡骨远端骨巨细胞瘤患者9例,男5例,女4例,年龄17～39岁,平均年龄29.6岁;其中左侧4例,右侧5例;按Campanacci影像学分级Ⅱ级3例,Ⅲ级6例。方法:全部患者均采用瘤段切除、同种异体桡骨远端骨关节移植,钢板内固定治疗,定期门诊随访,采用Mankin评分方法进行功能评定。主要观察指标:①腕关节活动度。②X射线平片表现。③Mankin评估结果及术后并发症。结果:9例患者均获得随访(门诊随访7例,电话随访2例),随访时间12～64个月。术后腕关节平均活动范围为掌屈32.8°,背伸44.4°;较术前掌屈29.4°,背伸26.7°明显提高。X射线可见骨愈合良好,未见明显骨质吸收。全部患者腕关节处均有不同程度的骨关节炎、关节间隙变窄等,但无疼痛出现。所有患者骨内无复发,仅1例术后2年软组织内复发,并再次行软组织内肿瘤切除,复发率为11%。9例患者中按Mankin标准评定,优3例,良4例,可1例,差1例,优良率为80%。所有患者未见肺部转移,异体骨植骨区及全身无排异反应,术后无感染、骨不连、不愈合、骨质明显吸收及钢板螺钉断裂松动等并发症。结论:瘤段切除复合同种异体骨移植重建腕关节治疗CampanacciⅢ级、复发及合并病理性骨折的桡骨远端骨巨细胞瘤术后复发率低,腕关节活动明显改善。BACKGROUND： The methods of reconstration after en bloc excision for the giant cell tumor of the distal radius is too more, but the wrist joint function is not good after these methods. The report about allogenic osteoarticular allograft to contrast the bone joint defect of distal radius is rare. OBJECTIVE： To evaluate the functional outcome of osteoarticular allograft after en bloc excision and allogenic osteoarticular allograft to treat the giant cell tumor of the distal radius. DESIGN, TIME AND SETTING： A retrospective case analysis was performed at Department of Orthopaedics, West China Hospital, Sichuan University from July 2003 to January 2008. PARTICIPANTS： Nine patients with the giant cell tumor of the distal radius, including five males and four females and aged 17 39 years （mean age of 29.6 years） were selected from Department of Orthopaedics, West China Hospital, Sichuan University The tumor of four cases occurred on the left, and five on the right side. Based on Campanacci imaging standard, 3 cases were classified into grade Ⅱ and 6 were into grade Ⅲ. METHODS： All the patients with the giant cell tumor of the distal radius were treated with allogenic osteoarticular allograft after en bloc excision and plate implantation. By following up in regularity, function of wrist joint was evaluated using Mankin score. MAIN OUTCOME MEASURES： ①Wrist joint range of motion;②evaluation of the X radiograph;③Mankin evaluation and complications after surgery. RESULTS： Nine patients accepted the following up, including 7 in out-patient clinic and 2 on the phone. The following up time was 12-64 months. Postoperatively, Wrist joint range of motion was palmar flexion 32.8° and dorsal extension 44.4°, which was significantly higher than preoperation （palmar flexion 29.4° and dorsal extension 26.7°）. X-ray showed that the bone was well healed, and bone absorption was not observed. All patients had osteoarthritis and the joint space was narrowed to a certain degree, but painfulness was not f

关 键 词：骨移植 巨细胞瘤 桡骨 

分 类 号：R318[医药卫生—生物医学工程]