Clinical Efficacy Analysis And Treatment Experience Of Giant Cell Tumor Of Distal Radius

Objective:The clinical cases of 21 patients with giant cell tumor of distal radius treated in our hospital since 2005 were analyzed retrospectively.To explore the curative effect of two kinds of operation methods: bone grafting after curettage of tumor focus and free fibular head transplantation after resection of tumor segment and anastomosing blood vessel to reconstruct radiocarpal joint.So as to provide reference for the selection of surgical methods.Method:Twenty one patients with giant cell tumor of the distal radius admitted to our hospital from March 2005 to March 2019 were selected for retrospective study.According to the Campanacci classification and operation methods of giant cell tumor of the radius,they were divided into two groups: group A(13 cases)underwent tumor curettage add residual cavity filling(bone graft or cement).group B(8 cases)Cases were treated with tumor resection and vascularized fibula transplantation to reconstruct the radiocarpal joint.The clinical stage,indication of operation,operation time,bleeding volume,hospital stay,recurrence rate,wrist movement,hand grip strength and MSTS score were analyzed by statistical method.Result:21 patients were followed up for 11 to 48 months,with an average of 22.1 months.Group A: 13 patients had local recurrence after curettage and filling operation,the recurrence rate was 23.1%.After the recurrence,complete tumor resection and vascularized autograft of fibula small head were performed,the wrist joint function was well,no patient had lung metastasis.operation time: 96.83±3.07 minutes,intraoperative hemorrhage: 95.85±3.63 ml,hospital stay: 9.15±0.89 days.Wrist joint mobility: palm flexion was 35.01±1.02°,back extension was 31.02±0.81°,ulnar deviation was 24.03±3.61°,radial deviation was 13.81±1.01°,grip strength and healthy side accounted for 69.01±3.93%.MSTS score: good in 10 cases,medium in 3 cases.Group B: no local recurrence and lung metastasis of the tumor,no nonunion,delayed healing,infection,subluxation of the wrist joint,injury of the common peroneal nerve and other complications were found.The operation time was 182.03±8.23 minutes,intraoperative bleeding volume was 100.63±2.92 ml,hospital stay days were 11.63 ±0.92 days,wrist joint mobility: palm flexion was 41.41±1.06°,back extension was 40.02±2.11 °,ulnar deviation was 25.03±0.81°,radial deviation was 20.91±1.55°,the grip strength was 87.01±1.73% compared with the healthy side.MSTS score: excellent in 6 cases,good in 2 cases.The appearance and mobility of wrist joint,grip strength of affected hand and MSTS score were all better than those of group A.Conclusion:Imaging examination plays an important role in the diagnosis,staging and treatment of giant cell tumor of the distal radius.The recovery of wrist function after operation was significantly improved compared with before operation.The recurrence rate of curettage and filling operation is high;the function of wrist joint is relatively no significant improvement compared with that before operation,and the patient's satisfaction is not good;while the treatment of stage II and III giant cell tumor of distal radius with free fibula transplantation and reconstruction of tumor segment and anastomosing blood vessel not only completely removes the tumor cells,effectively reduces the recurrence rate of tumor,but also reconstructs the function of radial wrist joint,greatly reduced the disability rate of wrist joint.It is the best choice for the treatment of giant cell tumor of the distal radius.It is the only choice for the recurrence of giant cell tumor of the distal radius after curettage and filling,but its long-term effect and complications need further follow-up observation.