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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

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