Clarkson Paul W, Sandford Kelly, Phillips Amy E, Pazionis Theresa J C, Griffin Anthony, Wunder Jay S, Ferguson Peter C, Masri Bassam A, Goetz Thomas
Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada.
J Hand Surg Am. 2013 May;38(5):935-940.e1. doi: 10.1016/j.jhsa.2012.12.026. Epub 2013 Feb 27.
Wrist arthrodesis after resection of a giant cell tumor of the distal radius can be performed using a vascularized free fibular transfer (VFFT) or a nonvascularized structural iliac crest transfer (NICT). The purpose of this study was to compare the union times, functional outcomes, and complications after these procedures.
We identified 27 patients at 2 centers: 14 underwent VFFT, and 13 NICT. The 2 groups were comparable for age, sex, and tumor grade. We assessed functional outcomes of the wrist with the Toronto Extremity Salvage Score, Musculoskeletal Tumor Society 1987 and 1993 scores, and Disabilities of the Arm, Shoulder, and Hand scores.
Two local recurrences occurred in the VFFT group and 1 in the NICT group. The VFFT group had 3 patients who had already undergone or were planning to undergo surgery for improved appearance, hardware removal, or tendon release. In the NICT group, 2 infections required debridement, one of which went on to free fibular transfer, but there were no reoperations for nonunion or donor site morbidity. The surgical time was significantly shorter for NICT. Functional scores showed no differences between groups on any of the parameters studied for the upper limb.
Both VFFT and NICT were effective surgical techniques for wrist fusion after distal radial resection for giant cell tumor. Vascularized free fibular transfer should be considered when a major skin defect is anticipated, because it allows the inclusion of a vascularized skin paddle, or when the osseous defect is too long (> 10 cm) for NICT. We were unable to demonstrate a difference in upper limb functional scores between VFFT and NICT. Because the surgical time is significantly shorter and the reoperation rate is lower for NICT, we recommend NICT whenever possible.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic III.
桡骨远端巨细胞瘤切除术后的腕关节融合术可采用带血管游离腓骨移植（VFFT）或非带血管结构性髂嵴移植（NICT）来进行。本研究的目的是比较这些手术方法后的愈合时间、功能结果及并发症。
我们在2个中心确定了27例患者：14例行VFFT，13例行NICT。两组在年龄、性别和肿瘤分级方面具有可比性。我们采用多伦多肢体挽救评分、肌肉骨骼肿瘤学会1987年和1993年评分以及上肢、肩部和手部功能障碍评分来评估腕关节的功能结果。
VFFT组发生2例局部复发，NICT组发生1例。VFFT组有3例患者已经接受或计划接受手术以改善外观、取出内固定物或松解肌腱。在NICT组，2例感染需要清创，其中1例后来进行了游离腓骨移植，但没有因骨不连或供区并发症而再次手术。NICT的手术时间明显更短。功能评分显示，两组在上肢所研究的任何参数上均无差异。
VFFT和NICT都是桡骨远端巨细胞瘤切除术后腕关节融合的有效手术技术。当预计有较大皮肤缺损时，应考虑带血管游离腓骨移植，因为它可包含带血管的皮瓣，或者当骨缺损对于NICT来说过长（>10 cm）时也应考虑。我们未能证明VFFT和NICT在上肢功能评分上存在差异。由于NICT的手术时间明显更短且再次手术率更低，我们建议尽可能采用NICT。
研究类型/证据水平：治疗性III级。
