Treatment of giant cell tumor of the distal radius
Treatment of giant cell tumor of the distal radius
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DOI：
10.1097/00003086-200102000-00026
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发表时间：
2001-02-01
影响因子：
4.2
通讯作者：
Hsu, RWW
中科院分区：
文献类型：
--
作者：
Cheng, CY;Shih, HN;Hsu, RWW
对1982年至1995年间12例桡骨远端巨细胞瘤的手术治疗结果进行了回顾。所有12例患者均为III级病变。 12例患者中，6例采用病灶内刮除局部切除术，另外6例患者接受全髁整块切除（其中4例采用同种异体骨关节移植，另2例采用自体腓骨移植）重建，以保留功能关节。没有出现感染、移植物断裂、种植体失败或骨不连等早期或晚期并发症。在平均6年（范围3-16年）随访期间，两组均未发现局部肿瘤复发。在接受病灶内刮除术治疗的患者中观察到最好的功能结果。切除组的功能结果良好，对侧平均运动范围达到69%（范围，56%-83%），握力达到70%（范围，63%-77%）。尽管由于肿瘤手术原因，整块切除术更常用于这些病变，但不应排除病灶内切除作为 III 级病变的可能治疗方法。 Ⅲ级病变，当肿瘤未侵犯腕部、破坏皮质层50%以上，或突破皮质层且多平面有骨外肿块时，行刮除术。当存在病灶刮除禁忌症时，建议在这种非负重关节中进行整块切除后用同种异体骨关节重建。
The results of surgical treatment of giant cell tumors of the distal radius were reviewed in 12 patients between 1982 and 1995. All 12 patients had Grade III lesions. Six of the 12 patients were treated using intralesional curettage with local excision, and the other six patients underwent en bloc resection with total condyle (four of the six by osteoarticular allograft, and the other two by fibular autograft) reconstruction with the aim of preserving the functional joint. There were no early or late complications such as infection, graft fracture, implant failure, or nonunion. No local tumor recurrence was seen in either group during the average followup of 6 years (range, 3-16 years). The best functional result was seen in the patients treated with intralesional curettage. The functional result of the resection group was good, achieving an average of 69% (range, 56%-83%) of their range of motion and 70% (range, 63%-77%) of their grip strength on the contralateral side. Intralesional excision should not he excluded as a possible treatment of Grade III lesions, although en bloc resection was used more commonly for these lesions because of tumor surgery reasons. Grade III lesions were treated with curettage when the tumor did not invade the wrist, destroy more than 50% of the cortex, or break through the cortex with an extraosseous mass in more than one plane. Reconstruction with osteoarticular allograft after en bloc resection is recommended in this non-weightbearing joint when there is contraindication for curettage of the lesion.