Efficacy Analysis Of Surgical Treatment Of The Distal Radius Giant Cell Tumors

Objective：To evaluate the distal radius bone curettage of giant cell tumor ofbone graft and of tumor resection semi wrist replacement surgery twosurgical efficacy, summary of the distal radius bone giant cell tumor ofthe surgical treatment of surgical methods, the local recurrence rate,complications andwrist function, to explore reasonable treatment of giantcell tumor of the distal radius.Methods：Between March2005and April2012,28patients with giant celltumor of the distal radius were treated in our department.There were12males, and16females, with an average age of30years old. According tothe giant cell tumor Campanacci classification [1],20patients weretreated by sac doctoring and bone cement or autologous bone or allograftfilling.9cases of them are male, the others are female.8patients aretreated by tumor resection, prosthesis replacement and wrist jointreconstruction.3cases of8cases are male,5cases are female, aged20~50years old, of which4cases were diagnosed first time,4cases aretumor recurrence after curettage and bone graft. Resecting tumor sectionout of capsule, implanting artificial prosthesis, reconstructing wrist joint, follow-up X-ray manifestations and function evaluation. From theaverage surgery time, the average length of the incision, the averagelength of stay, the average amount of bleeding, the recurrence rate,postoperative follow-up X-ray findings, the activity of the wrist andMSTS evaluation.All patients were taken ratio of X-ray and MR accurate measurementof tumor length and medullary cavity diameter to custom fit the diameterand shape of the radial bone prosthesis, good preoperative design to avoidprosthesis morphology and medullary cavity morphologydiscrepancies,insert the prosthesis difficult line of MR imaging clear boundaries of thetumor and the soft tissue, imaging classification. Custom prosthesis in ourhospital just for radial prosthesis (Figure7), the distal end of theprosthesis polyethylene material, strictly in accordance with the normaldistal radius manufacturing, to better fit metacarpal. The distal end of theprosthesis with a number of channels, in order to rebuild the wrist.All patients were divided into2groups, group A: intracapsularcurettage, bone cement or autologous bone or allogeneic bone filling20cases. Group B: tumor resection and prosthetic replacement wristreconstruction of eight cases.. A group of20patients underwentcurettage and carbolic acid burning and bone cement or since the bodybone or allogeneic bone plombage, take the dorsal wrist incision, cut theskin, subcutaneous tissue, separating the dorsal wrist tendon and free, revealing tumors, showing severe bone destruction, cortical bone meagersome cases, tumors and even break through the cortical bone, violationsof the surrounding soft tissue. At the same time protect the surroundingsoft tissue, bone scuttling window, the curette tumor cavity in alldirections thoroughly scrape the tumor tissue, mostly Hazelgranulomatous tissue with carbolic acid burning aneurysm cavity wall.Take the appropriate size of the iliac bone, implanted in the distal radiustumor cavity, filling indeed, also available bone cement lesions. Gypsumfixed to the bone graft bone healing. Group B: after the entry into force ofthe anesthesia, the patient supine. Conventional surgery area disinfection,shop sterile surgical towels single, on tourniquet. Take the the wristdorsal incision (Figure8), cut the skin, subcutaneous tissue, separateddorsal wrist tendon and its free, visible the distal radius4.0cmX3.0cmsize tumor, the tumor has exceeded the cortical bone surgery, andviolations of the surrounding organization, and as applied in accordancewith the principles of Enneking surgical the extracapsular free tumor andresection invaded surrounding tissue, continue to the proximal radial freeprogram purposes in accordance with the design of the osteotomypreoperative osteotomy bone saw to saw off the radial distance the tumorboundary5cm proximal complete remove the tumor sections (Figure9),to keep as pathological. The medullary cavity file cleanup radial bonemarrow cavity expansion of the medullary cavity and then with a series of medullary cavity filing until cancellous bone completely worn out (Figure10), line C-arm fluoroscopy understand joint centered at the normalheight of the radiocarpal joint will be stirred well bone cement into themedullary cavity, and then placed in custom the artificial radial boneprosthesis, bone cement, reset radioulnar joint and wrist (Figure11),suture periarticular ligament tissue reconstruction wrist activities wrist.Open tourniquet, complete hemostasis, wash the wound, the inventory thecorrect gauze instruments, suture around the joint organization, layerclosure wound activities wrist. Check patient ipsilateral fingers feelingactivities after recovery from anesthesia. The cast immobilization wrist infunctional positions.Results：28cases have been followed up, the mean duration of follow-up for28cases was35months, the recurrence rate in follow-up period was20%in group A, average activity of wrist: palm flexion40°and back stretch32°,ulnar deviation30°, radial deviation15°, forearm rotation mean:pronation36°, supination33°, B group did not find local recurrence anddistant metastasis, joint prothesis rejection and infection, artificial jointprosthesis appear no complications:looseness, fracture and dislocation inshort term, average activity of wrist: palm flexion46°and back stretch35°,ulnar deviation35°, radial deviation15°, forearm rotationmean:pronation36°, supination33°, wrist joint function is good. Conclusion：1Two groups in the average operative time, with an average length ofstay, the average amount of bleeding was no significant difference; Agroup incision length shorter than that in group B;2Simple to scrape bone graft or bone cement filling higher recurrencerate, tumor resection the prosthetic replacement giant cell tumor of thedistal radius bone, radical resection of the tumor, not only reduces therecurrence rate, also no significant effect on the function of the wrist, is abetter choice for the treatment of distal radius bone giant cell tumor,especially for malignant giant cell tumor, but its long-term efficacy andcomplications still remains to be seen.3Two surgical approaches to the treatment of distal radius bonegiant cell tumor is effective, but the choice of surgical methods rely oncareful preoperative assessment.4retrospective analysis of the small number of cases, the resultsobtained there are some limitations on the accuracy andcomprehensiveness, still need a larger sample for further analysis.