Sullivan Mikaela H, Townsley Sarah H, Rizzo Marco, Moran Steven L, Houdek Matthew T
Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
Division of Plastic and Reconstructive Surgery, Mayo Clinic, Rochester, MN, USA.
J Orthop. 2023 Jun 2;41:47-56. doi: 10.1016/j.jor.2023.06.001. eCollection 2023 Jul.
The distal radius is the most common location for giant cell tumors (GCT) in the upper extremity. Treatment should balance the goals of maximizing function and minimizing recurrence and other complications. Given the complexity in surgical treatment, various techniques have been described without clear standards of treatment.
The purpose of this review is to provide an overview of evaluation of patients presenting with GCT of the distal radius, discuss management, and provide an updated summary on outcomes of treatment options.
Surgical treatment should consider tumor Grade, involvement of the articular surface, and patient-specific factors. Options include intralesional curettage and en bloc resection with reconstruction. Within reconstruction techniques, radiocarpal joint preserving and sparing procedures can be considered. Campanacci Grade 1 tumors can be successfully treated with joint preserving procedures, whereas for Campanacci Grade 3 tumors consideration should be given to joint resection to prevent recurrence. Treatment of Campanacci Grade 2 tumors is debated in the literature. Intralesional curettage and adjuvants can successfully treat cases where the articular surface can be preserved, while en-bloc resection should be used in cases where the articular surface cannot undergo aggressive curettage. A variety of reconstructive techniques are used for cases needing resection, with no clear gold standard. Joint sparing procedures preserve motion at the wrist joint, whereas joint sacrificing procedures preserve grip strength. Choice of reconstructive procedure should be made based on patient-specific factors, considering relative functional outcomes, complications, and recurrence rates.
桡骨远端是上肢骨巨细胞瘤（GCT）最常见的发病部位。治疗应在最大化功能以及最小化复发和其他并发症之间寻求平衡。鉴于手术治疗的复杂性，已有多种技术被描述，但尚无明确的治疗标准。
本综述旨在概述桡骨远端GCT患者的评估，讨论治疗方法，并提供治疗选择结果的最新总结。
手术治疗应考虑肿瘤分级、关节面受累情况以及患者的个体因素。治疗选择包括病灶内刮除术和整块切除并重建。在重建技术中，可以考虑保留桡腕关节和尽量减少损伤的手术。坎帕纳奇1级肿瘤可通过保留关节的手术成功治疗，而对于坎帕纳奇3级肿瘤，应考虑关节切除以预防复发。坎帕纳奇2级肿瘤的治疗在文献中存在争议。病灶内刮除术及辅助治疗可成功治疗关节面可保留的病例，而对于关节面无法进行积极刮除的病例，则应采用整块切除术。对于需要切除的病例，使用了多种重建技术，但尚无明确的金标准。保留关节的手术可保留腕关节的活动度，而牺牲关节的手术可保留握力。重建手术的选择应基于患者的个体因素，同时考虑相对功能结果、并发症和复发率。
