Objective: To evaluate the long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor (GCT) of distal radius.
Methods: Between December 2010 and December 2014, 10 patients with Campanacci grade Ⅲ GCT of distal radius were treated with en bloc excision and inradiocarpal joint reconstruction using vascularized fibula flap. They were 6 males and 4 females, with an average age of 39.9 years (range, 22-65 years). The disease duration was 1.5-6.0 months (mean, 2.6 months). The length of distal radius defect was 6.0-12.5 cm (mean, 8.4 cm) after en bloc excision of GCT. Vascularized fibula flap with inferior lateral genicular vessels were performed in 6 patients and with inferior lateral genicular vessels and peroneal vessels in 4 cases.
Results: All incisions healed by first intention. All patients were followed up 4.4-8.3 years (mean, 6.0 years). There was no tumor recurrence during follow-up. At last follow-up, the mean ranges of motion of wrist joint were 55.0° (range, 25-85°) in extension, 26.5° (range, 15-40°) in flexion, 12.0° (range, 5-25°) in radial deviation, 19.6° (range, 10-30°) in ulnar deviation, 50.5° (range, 5-90°) in pronation, and 66.5° (range, 20-90°) in supination. The mean grip strength of effected wrist was 75% (range, 60%-85%) of the healthy wrist. The mean Musculoskeletal Tumor Society (MSTS) score was 82.7% (range, 75%-90%). X-ray films showed that the fibula flap healed at 12-16 weeks after operation (mean, 14.1 weeks) and there were 9 cases of radiological complications.
Conclusion: For Campanacci grade Ⅲ GCT of distal radius, application of the vascularized fibula flap in radiocarpal joint reconstruction after en bloc excision of GCT can obtain good wrist function.
目的: 总结 Campanacci Ⅲ级桡骨远端骨巨细胞瘤（giant cell tumor，GCT）瘤段切除后，采用带血管蒂自体腓骨瓣移植重建桡腕关节的远期疗效。.
方法: 2010 年 12 月—2014 年 12 月，收治 10 例 Campanacci Ⅲ级桡骨远端 GCT 患者。其中男 6 例，女 4 例；年龄 22～65 岁，平均 39.9 岁。病程 1.5～6.0 个月，平均 2.6 个月。4 例合并病理性骨折。肿瘤切除后桡骨远端骨缺损长度为 6.0～12.5 cm，平均 8.4 cm。采用自体腓骨瓣移植重建桡腕关节，6 例吻合膝下外侧血管，4 例吻合膝下外侧血管+腓血管双套血管蒂。.
结果: 术后切口均Ⅰ期愈合。患者均获随访，随访时间 4.4～8.3 年，平均 6.0 年。随访期间肿瘤无复发。末次随访时，腕关节活动范围：背伸 25～85°，平均 55.0°；掌屈 15～40°，平均 26.5°；桡偏 5～25°，平均 12.0°；尺偏 10～30°，平均 19.6°；前臂旋前 5～90°，平均 50.5°；旋后 20～90°，平均 66.5°。患侧握力达健侧 60%～85%，平均 75%。美国骨与软组织肿瘤协会（MSTS）评分为 75%～90%，平均 82.7%。X 线片复查示移植腓骨瓣均愈合，愈合时间 12～16 周，平均 14.1 周；9 例出现影像学并发症。.
结论: Campanacci Ⅲ级桡骨远端 GCT 切除后，采用带血管蒂腓骨瓣移植重建桡腕关节，能够有效保留腕关节功能。.
Keywords: Giant cell tumor; fibular graft; functional reconstruction; radiocarpal joint.