Flouzat-Lachaniette Charles-Henri, Babinet Antoine, Kahwaji Antoine, Anract Philippe, Biau David-Jean
Service de Chirurgie Orthopédique et Traumatologie B, Hôpital Cochin, AP-HP/Université Paris Descartes, Paris, France.
J Hand Surg Am. 2013 Aug;38(8):1505-12. doi: 10.1016/j.jhsa.2013.04.026. Epub 2013 Jun 25.
To present the functional results of a technique of radiocarpal arthrodesis and reconstruction with a structural nonvascularized autologous bone graft after en bloc resection of giant cell tumors of the distal radius.
A total of 13 patients with a mean age of 37 years with aggressive giant cell tumor (Campanacci grade III) of distal radius were managed with en bloc resection and reconstruction with a structural nonvascularized bone graft. The primary outcome measure was the disability evaluated by the Musculoskeletal Tumor Society rating score of limb salvage. Secondary outcomes included survival of the reconstruction measured from the date of the operation to revision procedure for any reason (mechanical, infectious, or oncologic). Other outcomes included active wrist motion and ability to resume work.
Mean follow-up period was 6 years (range, 2-14 y). The median arc of motion at the midcarpal joint was 40°, median wrist flexion was 20°, and median extension was 10°. The median Musculoskeletal Tumor Society score based on the analysis of factors pertinent to the patient as a whole (pain, functional activities, and emotional acceptance) and specific to the upper limb (positioning of the hand, manual dexterity, and lifting ability) was 86%. Five patients underwent a second surgical procedure. The cumulative probability of reoperation for mechanical reason was 31% at similar follow-up times at 2, 5, and 10 years.
This technique provided a stable wrist and partially restored wrist motion with limited pain. However, further surgical procedures may be necessary to reach this goal.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.
介绍桡骨远端整块切除术后采用非血管化自体结构性骨移植进行腕关节融合与重建技术的功能结果。
对13例平均年龄37岁的桡骨远端侵袭性巨细胞瘤（坎帕纳奇III级）患者进行整块切除，并用非血管化结构性骨移植进行重建。主要结局指标是通过肌肉骨骼肿瘤学会肢体挽救评分评估的残疾情况。次要结局包括从手术日期到因任何原因（机械性、感染性或肿瘤性）进行翻修手术的重建存活率。其他结局包括腕关节主动活动度和恢复工作的能力。
平均随访期为6年（范围2 - 14年）。腕中关节的中位活动弧度为40°，腕关节中位屈曲度为20°，中位伸展度为10°。基于对患者整体相关因素（疼痛、功能活动和情感接受度）以及上肢特定因素（手部位置、手部灵巧度和举重能力）分析的肌肉骨骼肿瘤学会中位评分为86%。5例患者接受了二次手术。在2年、5年和10年相似的随访时间点，因机械原因再次手术的累积概率为31%。
该技术提供了稳定的腕关节，部分恢复了腕关节活动度，疼痛有限。然而，可能需要进一步的手术来实现这一目标。
研究类型/证据水平：治疗性IV级。
