上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

桡骨远端骨巨细胞瘤患者术后腕关节稳定性影像学参数与预后的关系

臧仕昭，张伟滨，沈宇辉   

  1. 上海交通大学 医学院附属瑞金医院骨科，上海 200025
  • 出版日期:2017-09-28 发布日期:2017-10-10
  • 通讯作者: 沈宇辉，电子信箱：yuhuiss@163.com
  • 作者简介:臧仕昭（1992—），男，博士生；电子信箱：sousisyou@sjtu.edu.cn
  • 基金资助:
     上海市教育委员会高峰高原学科建设计划（20152204）

Relationship between radiographic parameters for postoperative wrist joint stability and the prognosis of patients with giant cell tumor of distal radius#br#

ZANG Shi-zhao, ZHANG Wei-bin, SHEN Yu-hui   

  1. Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2017-09-28 Published:2017-10-10
  • Supported by:
    Shanghai Municipal Education Commission—Gaofeng Clinical Medicine Grant Support, 20152204

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摘要： 目的 · 分析桡骨远端Campanacci 3 级骨巨细胞瘤患者的预后及其与术后腕关节稳定性相关影像学参数的关系。方法 · 收集 2003 年 8 月—2016 年 7 月接受肿瘤广泛切除联合同侧自体腓骨重建术的 15 例桡骨远端 Campanacci 3 级骨巨细胞瘤患者资料，对临 床及影像学资料进行回顾，分析患者预后及其与腕关节稳定性相关影像学参数的关系。结果 · 15 例患者中14 例完成随访，1 例失 访；平均随访时间为（62.3±43.3）个月。患者术前和术后国际骨与软组织肿瘤协会（MSTS）评分分别为 21.6±2.0 和 23.1±2.2，功 能有所改善，但差异无统计学意义（P=0.106）。与术前比较，术后疼痛评分（MSTS）和生活功能评分（MSTS）改善显著（4.1±0.5 vs 2.9±0.7，P=0.000；3.7±0.7 vs 3.0±0.7，P=0.012）。相比对侧，术后患侧腕关节的关节活动度为（63.4±12.6）%，握力为 （68.5±10.8）%。5 例出现并发症（占 35.7%）, 其中感染 1 例，骨不连 3 例，半脱位 1 例；无下肢功能障碍病例。术后 MSTS 评分为 “良”和“优”患者的侧位片腓尺夹角分别为8.8?±5.6? 和 2.2?±2.4?（P=0.018）；克氏针取出前后尺腓关节间隙的差异有统计学意义 （P=0.003）。 Pearson 相关性分析结果显示骨愈合时间与取出克氏针后的腓骨尺偏角呈正相关（r=0.60，P=0.022）。 结论 · 对于桡骨远 端骨巨细胞瘤广泛切除联合同侧自体腓骨重建术患者，其预后可能与术后腕关节稳定性相关影像学参数有关。这对腓骨重建有一定的 指导意义。

关键词: 骨巨细胞瘤, 桡骨远端, 广泛切除术, 自体腓骨重建, 影像学参数

Abstract:

Objective · To analyze whether the radiographic parameters for wrist joint stability and some clinical features are associated with the prognosis of Campanacci grade 3 distal radial giant cell tumor of bone.  Methods · Clinical and radiological data of 15 patients with giant cell tumors of distal radius who were treated with wide en bloc excision with fibular autograft and internal fixation from August 2003 to July 2016 were retrospectively reviewed. The relationship between clinical features (including age, tumor size, pathological fracture, articular invasion, primary or recurrent), radiographic parameters for wrist joint stability and the prognosis was investigated statistically.  Results · There was only 1 patient lost at last follow-up. The average duration of follow-up was 62.3 ±43.3 months. The MSTS score was 21.6±2.0 before surgery and 23.1±2.2 after surgery with recovered function, although the difference was not significant statistically (P=0.106). The pain score (MSTS) improved significantly with 2.9±0.7 before and 4.1±0.5 after operation (P=0.000). The function score (MSTS) was 3.0±0.7 preoperatively and 3.7±0.7 postoperatively (P=0.012). The postoperative ranges of motion and grip strength compared to contralateral extremity were (63.4±12.6) % and (68.5±10.8)% respectively. Complications occurred in 5 patients (35.7%), with 1 infection, 3 non-union and 1 subluxation. No patient suffered from dysfunction of common peroneal nerve. The fibuloulnar angle after K wire removed was significantly larger in good MSTS group (8.8?±5.6?) than in excellent MSTS group (2.2?±2.4?) (P=0.018). The interval of distal fibuloulnar joint before and after K wire removed was significantly different (P=0.003). The Pearson correlation analysis suggested the time of bone union was positively correlated with fibular inclination (r=0.60, P=0.022).  Conclusion · The radiographic parameters for wrist joint stability are associated with the patients' prognosis after wide en bloc excision and fibular autograft, which may guide the fibular reconstruction.

Key words:  giant cell tumor of bone, distal radius, wide en bloc excision, fibular autograft, radiographic parameter