一种使用三叶形钢板的改良尺骨移位重建技术治疗桡骨远端Campanacci 3级骨巨细胞瘤。
A modified ulnar translocation reconstruction technique for Campanacci grade 3 giant cell tumors of the distal radius using a clover leaf plate.
作者信息
McLean James M, Clayer Mark, Stevenson Aaron W, Samson Anthony J
机构信息
*Division of Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK †Discipline of Orthopaedics and Trauma, University of Adelaide ‡Department of Orthopaedics and Trauma, Royal Adelaide Hospital §University of Adelaide Centre for Orthopaedic and Trauma Research, Royal Adelaide Hospital, North Terrace, Adelaide, SA, Australia.
出版信息
Tech Hand Up Extrem Surg. 2014 Sep;18(3):135-42. doi: 10.1097/BTH.0000000000000053.
BACKGROUND
Campanacci grade 3 giant cell tumors of the distal radius are locally aggressive and in close proximity to the median nerve, articular cartilage, flexor and extensor tendons, and the radial artery. Although several reconstructive techniques have been described, it is unclear to what degree these procedures restore function.
DESCRIPTION OF TECHNIQUE
We present a modified ipsilateral ulna translocation technique using a clover leaf plate, for reconstruction of en bloc resected distal radius. This has the theoretical advantage of ensuring a solid, pain-free wrist arthrodesis, while preserving the forearm rotational axis and minimizing functional loss, without the associated donor site morbidity or allograft rejection issues of other reconstructive techniques.
PATIENTS AND METHODS
Between 2006 and 2013, 3 patients underwent this procedure for Campanacci grade 3 giant cell tumors. All patients were right hand-dominant females, aged 24, 35, and 46 years, respectively. Two cases involved the right radius. Patients were reviewed retrospectively with clinical examination, functional assessment [the Toronto Extremity Salvage Score (TESS) for upper limb], and radiographs. The review period was 30, 51, and 41 months, respectively.
RESULTS
The length of distal radius resected was 70, 50, and 35 mm, respectively. All achieved clear margins. There were no complications and there have been no recurrences. All ulnocarpal translocations achieved radiographic fusion. Patient's averaged 80-degree pronation, 70-degree supination, and clinical TESS scores of 86 at most recent follow-up.
CONCLUSIONS
This technique achieved a painless and functional wrist arthrodesis with partially restored wrist motion, without complications. This technique has the advantage of negating remote donor site morbidity and/or allograft rejection issues of other techniques.
LEVEL OF EVIDENCE
Level III, therapeutic study.
背景
桡骨远端Campanacci 3级骨巨细胞瘤具有局部侵袭性，且紧邻正中神经、关节软骨、屈肌腱和伸肌腱以及桡动脉。尽管已经描述了几种重建技术，但尚不清楚这些手术在何种程度上恢复了功能。
技术描述
我们介绍一种使用三叶形钢板的改良同侧尺骨移位技术，用于整块切除桡骨远端后的重建。这具有理论优势，可确保实现稳固、无痛的腕关节融合，同时保留前臂旋转轴并使功能损失最小化，且不存在其他重建技术相关的供区并发症或同种异体移植排斥问题。
患者与方法
2006年至2013年期间，3例患者因Campanacci 3级骨巨细胞瘤接受了该手术。所有患者均为右手优势的女性，年龄分别为24岁、三十五岁和46岁。2例累及右侧桡骨。对患者进行回顾性临床检查、功能评估[上肢的多伦多肢体挽救评分（TESS）]以及X线片检查。复查时间分别为30个月、51个月和41个月。
结果
切除的桡骨远端长度分别为70毫米、50毫米和35毫米。所有病例均实现切缘阴性。无并发症发生，也无复发。所有尺腕关节移位均实现了影像学融合。在最近一次随访时，患者平均旋前80度、旋后70度，临床TESS评分为86分。
结论
该技术实现了无痛且功能良好的腕关节融合，腕关节活动部分恢复，且无并发症。该技术的优势在于避免了其他技术的远隔供区并发症和/或同种异体移植排斥问题。
证据级别
三级，治疗性研究。
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