| Objective:1.To study the morphological similarity between the proximal fibula and the distal radius.2.To study the anatomical characteristics of the blood supply of the proximal fibula,so as to provide anatomical basis for the clinical treatment of giant cell tumor of the distal radius by vascularized autologous fibula transplanting.3.To evaluate the clinical effect of vascularized autologous fibula transplanting for the treatment of giant cell tumor of distal radius.Methods:1.Digital anatomical study of the proximal fibular and distal radius:fourteen fresh frozen adult specimens filled with lead oxygen-gelatin were selected and scanned by high-resolution CT.3D visualization models of the morphology of the proximal fibular and distal radius and the intraskeletal blood supply of the proximal fibular were reconstructed using MIMICS software.The posterior inclination,medial inclination,articular surface shape and size of the proximal fibular were measured.The palmar inclination,ulnar inclination,articular surface shape and size of the distal radius were measured.The pedicle length of each nutrient artery,the outer diameter of each trophoblast vessel and the distance between the nutrient foramen on the fibula and the fibula head were measured.2.We retrospectively collected the clinical effect of 7 cases of radial giant cell tumor resection with vascularized autologous fibula transplantation.The time of bone healing,wrist range of motion,hand grip strength,VAS pain score,MSTS score,Quick DASH Score,PRWE Score and recurrence were recorded by regular follow-up.Results:1.MIMICS 21.0 was used to reconstruct the proximal fibula and the distal radius.The simulated ulnar inclination of the proximal fibula was(14.20±3.20)°,and the simulated palmar inclination was(31.35±6.84)°.The coronal length of the fibula articular surface was(22.01±3.31)mm,the sagittal length of the fibula articular surface was(17.42)±75)mm,and the size of the articular surface(60.90±7.64)mm~2.The ulnar inclination of the distal radius was(24.45±3.41)°,and the palmar inclination was(11.73±1.78)°.The coronal length of the radius articular surface was(25.73±2.61)mm,and the sagittal length was(15.42±1.64)mm,and he size of the articular surface(65.58±5.88)mm~2.The articular surface of the fibular is smaller than that of the distal radius.The simulated palmar inclination angle of the fibula is greater than that of the autologous ipsilateral distal radius,and the simulated ulnar declination is smaller than that of the autologous ipsilateral distal radius.The differences were statistically significant(P<0.05).MIMICS 21.0 was used to reconstruct the 3D vascular images of the proximal fibula.The blood supply of the proximal fibula mainly consist of the inferior lateral genicular artery,the circumflex fibular artery,the anterior tibial recurrent artery and the peroneal artery.In all specimens,the inferior lateral genicular artery originated from the popliteal artery,and the outer diameter of the inferior lateral genicular artery at the beginning was(2.83±0.29)mm,mostly entering the fibula near the fibula head.There were 3 branches in the head of the fibula on average,and the average length from the beginning of the inferior lateral genicular artery to the first branch of the head of the fibula was(33.78±6.34)mm.The origin of the circumflex fibula artery was as follows:popliteal artery in 12 cases,posterior tibial artery in 2 cases.The external diameter at the beginning of the circumflex fibular artery was(2.42±0.47)mm,and it entered the fibular bone at about the level of the fibular neck.The average length from the beginning of the circumflex fibular artery to the first branch of the fibular head was(37.59±13.13)mm,and the distance between the nutrient foramen on the fibula and the fibular head was(38.89±26.57)mm.The external diameter at the beginning of the anterior recurrent tibial artery was(3.18±0.19)mm.The average length from the beginning of the anterior tibial recurrent artery to the first branch of the fibula head was(47.43±7.28)mm.The distance between the nourish foramen on the fibula and the fibula head was(20.78±16.67)mm.The peroneal artery usually sends out the arterial arch at the middle part of the fibula to nourish the f midshaft of fibula.The outer diameter of the first arterial arch from the lower part of the fibula is(1.96±0.42)mm,and the length from the beginning of the first arterial arch to the fibula nutrient foramen is(8.59±2.90)mm.The distance between the nutrient foramen on fibula and the fibula head was(87.84±37.58)mm.2.Seven patients were followed up from 26 to 125 months(mean 83.2months).The wrist VAS pain score was(5.53±1.46)points before surgery and(1.12±0.41)points after surgery,indicating that the postoperative pain was significantly relieved.After operation,the average grip strength of wrist joint on the affected side was(24.32±4.26)kg,reaching 56%on the healthy side.Quick-dash scores were(26.97±7.52)points before operation and(11.75±4.53)points after operation.PRWE score was(32.92±8.41)points before operation and(15.47±6.42)points after operation.The MSTS score was(28.42±3.72)points before operation and(20.33±5.47)points after operation.The differences were statistically significant(P<0.05).Postoperative range of motion of wrist on affected side was 45.73°flexion,33°extension,11.23°ulnar deviation,16.42°radial deviation,60.56°pronation,55.62°supination.All the incisions were healed directly,without infection,neurovascular injury or knee instability.Dislocation of the radioulnar joint occurred in one patient after surgery,which healed after Kirschner wire fixation for 4 weeks.One patient developed local recurrence and pulmonary metastasis 2 years after surgery,and the osteotomy end remained unhealed 2 years after surgery.Conclusions:1.The morphology of the proximal fibula is similar to that of the distal radius.The simulated palmar inclination angle of the fibula is greater than that of the autologous ipsilateral distal radius,and the simulated ulnar declination is smaller than that of the autologous ipsilateral distal radius.2.The proximal fibular is rich in blood supply with multiple sources.The lateral inferior genicular artery is a reliable blood supply for proximal fibula,which are the preferred nutritional vessels for vascularized proximal fibula transplantation.3.Vascularized autologous proximal fibula transplantation is an effective method for the reconstruction of bone and joint defects after resection of giant cell tumor of distal radius. |
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