Department of Orthopedic Surgery, Kyung Hee University Hospital, School of Medicine, Kyung Hee University, Korea.
Microsurgery. 2013 Feb;33(2):112-8. doi: 10.1002/micr.22028. Epub 2012 Sep 13.
The purpose of this study was to report the clinical outcomes of wrist arthroplasty with a free vascularized fibular head graft (FVFHG) and to highlight some considerations that may affect outcomes. FVFHG was performed on 12 patients with giant cell tumors of the distal radius between April 1984 and July 2005. The mean age of patients was 33 years. All 12 patients were classified as Enneking stage 2. Outcomes were evaluated with radiographic and functional assessments, including the scale of Enneking. The mean follow-up period was 6.26 years. Bone union was achieved in all patients at a mean of 15.7 weeks after surgery. Skin grafting was performed at the recipient site in 5 patients and had good skin healing. Subluxation in the wrist joint was observed in 5 patients and was related to the length of the transplanted fibula. The 5 patients with subluxation experienced considerable osteoarthritic change. The mean arc of flexion-extension and rotation of the wrist joint was 73.1° and 102.9°, respectively. The mean grip strength was 57.25% of the contralateral side. The mean functional score was 26.4 points. Wrist arthroplasty with a FVFHG is a useful option to treat Enneking stage 2 giant cell tumors of the distal radius. We believe that wrist instability is not determined by the choice of laterality of the fibula, which can be minimized by transplanting a short fibula with the anterior tibial artery as a donor artery. The recipient sites can be successfully resurfaced by skin grafting.
本研究旨在报告游离血管化腓骨头移植（FVFHG）腕关节成形术的临床结果，并强调一些可能影响结果的因素。1984 年 4 月至 2005 年 7 月，我们对 12 例桡骨远端骨巨细胞瘤患者进行了 FVFHG。患者平均年龄为 33 岁。所有 12 例患者均按 Enneking 分期 2 期分类。采用 Enneking 评分量表对影像学和功能评估进行评估。平均随访时间为 6.26 年。所有患者均在术后 15.7 周实现骨愈合。5 例患者在受区行皮片移植，皮肤愈合良好。5 例患者出现腕关节半脱位，与移植腓骨的长度有关。5 例半脱位患者出现明显的骨关节炎改变。腕关节屈伸和旋转的平均弧分别为 73.1°和 102.9°。平均握力为健侧的 57.25%。平均功能评分为 26.4 分。游离血管化腓骨头移植腕关节成形术是治疗 Enneking 分期 2 期桡骨远端骨巨细胞瘤的有效方法。我们认为腕关节不稳定不是由腓骨的侧别决定的，通过移植带胫前动脉的短腓骨可以将其最小化。受区可以通过皮片移植成功覆盖。
