Zhang Shuai, Xu Mei-Tao, Wang Xu-Quan, Wang Jia-Jia
Orthopedics Department, Southwest Hospital, Third Military Medical University, 30 Gao Tan Yan Street, Sha Ping Ba District, 400038, Chongqing, China.
J Orthop Sci. 2015 Nov;20(6):1090-7. doi: 10.1007/s00776-015-0763-z. Epub 2015 Sep 2.
Giant cell tumors (GCT) of the distal radius at Campanacci grade II/III are particularly challenging to treat. Wide excision is the management of choice, but this creates a defect at the distal end of radius. We treated 11 cases of GCT of the distal radius by en bloc excision and custom prosthetic replacement. The purpose of this study was to present our experience and assess the functional outcomes of all patients treated with this surgery.
Between 2005 and 2014, we followed up 11 patients with GCT of the distal radius who were treated with en bloc excision and custom prosthetic replacement. All cases were evaluated based on clinical and radiological examinations, passive range of motion (ROM) of the wrist joint, complications, and Musculoskeletal Tumor Society (MSTS) score.
Mean follow-up period was 55.5 months (24-83 months); mean resected length of the radius was 7.9 cm. One patient had tumor recurrence in the soft tissues after 15 months (recurrence rate 9.09 %). No patient had fracture, recurrence in the bone, metastases, or immune rejection. No complications were seen, such as loosening, rupture, or dislocation of the custom prosthesis. One patient developed superficial infection at the operative site which resolved after a course of antibiotics for 4 weeks. One patient experienced pain, which could be endured without the need for analgesics. Average ROM was 40.9° of dorsiflexion, 30.0° of volar flexion, 46.4° of supination, and 38.2° of pronation. Mean grip strength was 71 % (42-86 %). Overall revised MSTS score averaged 80.3 % (63.3-93.3 %) with one being excellent, five good, and five satisfactory.
En bloc excision and custom prosthetic replacement for a Campanacci grade II/III GCT of the distal radius results in reasonable functional outcome at intermediate follow-up evaluation. Although average ROM of the ipsilateral wrist is poorer than some studies with other techniques, this method can be considered a reasonable option.
坎帕纳奇II/III级桡骨远端骨巨细胞瘤的治疗极具挑战性。广泛切除是首选治疗方法，但这会在桡骨远端造成缺损。我们采用整块切除及定制假体置换治疗了11例桡骨远端骨巨细胞瘤。本研究的目的是介绍我们的经验，并评估接受该手术治疗的所有患者的功能结局。
2005年至2014年期间，我们对11例接受整块切除及定制假体置换治疗的桡骨远端骨巨细胞瘤患者进行了随访。所有病例均根据临床和影像学检查、腕关节被动活动度（ROM）、并发症及肌肉骨骼肿瘤学会（MSTS）评分进行评估。
平均随访期为55.5个月（24 - 83个月）；桡骨平均切除长度为7.9 cm。1例患者在15个月后出现软组织肿瘤复发（复发率9.09%）。无患者发生骨折、骨复发、转移或免疫排斥反应。未出现定制假体松动、破裂或脱位等并发症。1例患者手术部位发生浅表感染，经4周抗生素治疗后痊愈。1例患者有疼痛，但无需使用镇痛药即可忍受。平均活动度为背伸40.9°、掌屈30.0°、旋后46.4°、旋前38.2°。平均握力为71%（42 - 86%）。总体改良MSTS评分平均为80.3%（63.3 - 93.3%），其中1例为优秀，5例为良好，5例为满意。
对于坎帕纳奇II/III级桡骨远端骨巨细胞瘤，整块切除及定制假体置换在中期随访评估中可获得合理的功能结局。尽管同侧腕关节的平均活动度比其他一些技术的研究结果要差，但该方法可被视为一种合理的选择。
