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目的比较不同方式腓骨近端移植重建桡骨远端骨巨细胞瘤(giant cell tumor,GCT)瘤段切除后骨关节缺损的疗效。方法 1966年11月至2009年3月,对24例桡骨远端GCT患者采用瘤段切除腓骨近端移植,其中15例为不带血供的腓骨近端移植(A组),9例为吻合血管游离移植(B组)。术后用DASH量表、Gartland和Werley(G/W)腕关节评分、PRWE评分和握力恢复率评价腕关节功能。结果 24例随访3.5~44年,平均9.3年。移植腓骨均顺利成活,骨愈合时间:A组2.5~8个月,平均4.7个月;B组3.5~6个月,平均4.3个月。随访期间肿瘤无复发。DASH量表评分2.5~13.3分,平均7.53分;G/W腕关节评分21例1~2分,优占87.5%,3例5~7分,良占12.5%;握力恢复率75%~104%,平均84.83%;PRWE评分10.5~33.0分,平均24.6分。带血供与不带血供腓骨近端移植在骨愈合时间、DASH量表评分、G/W评分、握力恢复率以及PRWE评分方面差异无统计学意义(P>0.05)。2例供区下肢偶有微痛,1例术后11年摔伤致结合部骨折,经保守治愈。结论腓骨近端移植是桡骨远端GCT瘤段切除后桡腕关节重建的理想方法之一;切取<12 cm腓骨近端移植可不带血供。
Objective To compare the curative effect of different methods of proximal fibular bone graft reconstruction of giant cell tumor (GCT) resection of bone and joint defects. Methods From November 1966 to March 2009, 24 patients with distant distal GCT underwent resection of the proximal fibular fibular graft, of which 15 were proximal fibular graft without blood supply (group A) and 9 patients were anastomosed Vascular free transplantation (group B). The function of the wrist joint was assessed with the DASH scale, the Gartland and Werley (G / W) wrist score, the PRWE score and the grip recovery rate after operation. Results 24 cases were followed up for 3.5 to 44 years with an average of 9.3 years. The fibula transplantation survived successfully. The healing time of the bone in group A was 2.5 to 8 months (average 4.7 months). Group B was 3.5 to 6 months (average 4.3 months). No recurrence of tumor during follow-up. DASH scale score of 2.5 to 13.3 points, an average of 7.53 points; G / W wrist score 21 cases of 1 to 2 points, excellent accounting for 87.5%, 3 cases of 5 to 7 points, good accounting for 12.5%; grip recovery rate of 75% to 104 %, An average of 84.83%; PRWE score 10.5 ~ 33.0 points, an average of 24.6 points. There was no significant difference in bone healing time, DASH scale score, G / W score, recovery rate of grip strength and PRWE score between proximal and distal fibula with or without blood supply (P> 0.05). 2 cases of occasional occasional slight pain for the lower limbs, 1 case of 11 years after the fall caused by fractures of the junction, the conservative cure. Conclusion The proximal fibular graft is one of the ideal methods for the reconstruction of the radiocarpal joint after resection of the distal radius of the GCT. The proximal fibula of <12 cm can be removed without blood supply.