全腕关节置换治疗桡骨远端骨巨细胞瘤  

Total wrist arthroplasty in the treatment of the giant cell tumor in distal radius

作　　者：谢志进[1] 胡云洲[1] 王彦川[1] 孙伟[1] 刘勇[1] 

机构地区：[1]成都市第七人民医院骨科,610041

出　　处：《中国骨肿瘤骨病》2011年第1期28-32,共5页Chinse Journal Of Bone Tumor And Bone Disease

摘　　要：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 efficacy of total wrist arthroplasty for reconstructing the joint function after resection of the giant cell tumor of distal radius. Methods From March 2005 to April 2009, 4 cases （2 females, 2 males, aged 23-66） with the giant cell tumor in distal radius were performed with total wrist arthroplasty. Of the 4 cases, 2 came for the first diagnosis, 1 sustained recurrence after tumor curettage and bone grafting, and 1 sustained recurrence after tumor curettage and bone cement filling. After the extra-capsular resection of tumor, artificial wrist joint was implanted to repair bone defects of distal radius and to reconstruct the wrist joint. After surgery, followup was made for the radiographical and functional evaluation. Results The mean followed-up was 25.5 months （range, 9-45 months）. During the follow-up period, of all the patients, no local tumor recurrence nor distant metastasis was found; no postoperative prosthesis immune rejection nor infection occurred; and in the short term, no complications was seen such as loosening, rupture, nor dislocation of the joint prosthesis. The average range of motion for wrist joint was： 48° flexion, 35° dorsiflexion, 36° ulnar deviation, and 15° radial deviation. The average forearm rotation degree was： 38° pronation, and 55° supination. The wrist functional assessment was good. Conclusions The total wrist arthroplasty in the treatment of the giant cell tumor in distal radius not only can completely remove the tumor, but also retaine the function of wrist joint. It is a good method for the giant cell tumor due to its lower recurrence rate and better postoperative function remains to be observed. in the distal radius, especially for the malignant ones, than other methods. However, its long-term efficacy

关 键 词：桡骨 巨细胞瘤 腕关节 关节置换术 

分 类 号：R738.1[医药卫生—肿瘤]