Ihara K, Doi K, Sakai K, Yamamoto M, Kanchiku T, Kawai S
Department of Orthopaedic Surgery, Yamaguchi University, School of Medicine, Japan.
Clin Orthop Relat Res. 1999 Feb(359):189-96. doi: 10.1097/00003086-199902000-00020.
Although hemiarthroplasty of the wrist using vascularized proximal fibula has been described often, long term results with documentation of results are insufficient. A case of giant cell tumor of the distal radius with remarkable extraskeletal extension is reported. Vascularized fibula including its proximal head was used to replace the defect created after en bloc resection of the tumor. There was no deterioration in radiographic findings or function of the new joint at the time of the 10-year followup. Satisfactory range of motion of the wrist and the forearm was maintained. There was no instability in the joint, and grip strength measured 65% of the opposite side. Postoperative magnetic resonance imaging showed survival of the whole graft, including the subchondral portion. In addition to thorough revascularization of the graft, appropriate soft tissue reconstruction using dynamic tendon transfer contributed to the success. When these requirements are fulfilled, the graft can provide a functional and durable result. Although this is a single experience, the authors recommend wrist arthroplasty, rather than arthrodesis, in carefully selected patients.
尽管使用带血管蒂的近端腓骨进行腕关节半关节成形术已有诸多报道，但长期结果及结果记录并不充分。本文报道了1例伴有显著骨外扩展的桡骨远端巨细胞瘤病例。采用包括近端头部的带血管蒂腓骨来替代肿瘤整块切除后形成的缺损。在10年随访时，新关节的影像学表现及功能均无恶化。腕关节和前臂保持了满意的活动范围。关节无不稳定，握力为对侧的65%。术后磁共振成像显示整个移植物存活，包括软骨下部分。除了移植物充分的血管再生外，采用动力肌腱转移进行适当的软组织重建也有助于手术成功。当满足这些要求时，移植物可提供功能良好且持久的效果。尽管这只是单一病例经验，但作者建议在精心挑选的患者中采用腕关节成形术而非关节融合术。
