Department of Surgery, Division of Plastic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
J Surg Oncol. 2022 Sep;126(4):798-803. doi: 10.1002/jso.26967. Epub 2022 Jun 1.
The distal radius is a common location for giant cell tumors (GCTs) of bone. Management includes intralesional curettage or wide excision, however, long-term comparisons of treatment options are limited. The purpose of the current study was to evaluate our institutions' outcomes of treatment of these tumors.
We reviewed 24 GCT of the distal radius in 23 patients (12 males: 11 females) with a mean age of 42 years at the time of surgery. Functional outcomes were collected including the Musculoskeletal Tumor Society Score (MSTS), QuickDash, the Visual Analog Scale (VAS), and the Patient Rated Wrist Evaluation (PRWE). The mean follow-up was 13 years.
Tumor grade included Campanacci Grade II (n = 14) and Grade III (n = 10). Treatment included extended intralesional curettage (n = 16) and wide excision (n = 8). Reconstruction mainly included bone grafting/cement (n = 16) or free vascularized fibula radiocarpal arthrodesis (n = 5). At most recent follow-up, there was no difference in MSTS, VAS, and PRWE (p > 0.05) between patients undergoing a joint sparing or arthrodesis. Patients undergoing arthrodesis had a lower QuickDASH score (13.7 vs. 20.8, p = 0.04) CONCLUSIONS: Treatment for GCT of the distal radius is individualized however in the setting of articular surface involvement, arthrodesis can lead to superior functional results at long-term follow-up.
桡骨远端是骨巨细胞瘤(GCT)的常见部位。治疗包括病灶内刮除或广泛切除,但治疗方案的长期比较有限。本研究的目的是评估我们机构治疗这些肿瘤的结果。
我们回顾了 23 例患者(12 名男性,11 名女性)的 24 例桡骨远端 GCT,手术时的平均年龄为 42 岁。收集了功能结果,包括肌肉骨骼肿瘤学会评分(MSTS)、快速残疾评定量表(QuickDash)、视觉模拟评分(VAS)和患者腕关节评估(PRWE)。平均随访时间为 13 年。
肿瘤分级包括 Campanacci 分级 II 级(n=14)和 III 级(n=10)。治疗包括广泛的病灶内刮除(n=16)和广泛切除(n=8)。重建主要包括骨移植/水泥(n=16)或游离带血管腓骨桡腕关节融合术(n=5)。在最近的随访中,行保关节或关节融合术的患者在 MSTS、VAS 和 PRWE 方面没有差异(p>0.05)。行关节融合术的患者 QuickDash 评分较低(13.7 比 20.8,p=0.04)。
桡骨远端 GCT 的治疗是个体化的,但在关节面受累的情况下,融合术可在长期随访中获得更好的功能结果。