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首页> 外文期刊>Journal of Hand Surgery. American Volume >Functional results following vascularized versus nonvascularized bone grafts for wrist arthrodesis following excision of giant cell tumors
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Functional results following vascularized versus nonvascularized bone grafts for wrist arthrodesis following excision of giant cell tumors

机译：血管化和非血管化骨移植术后巨大关节瘤切除后腕关节固定的功能结果

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Purpose: Wrist arthrodesis after resection of a giant cell tumor of the distal radius can be performed using a vascularized free fibular transfer (VFFT) or a nonvascularized structural iliac crest transfer (NICT). The purpose of this study was to compare the union times, functional outcomes, and complications after these procedures. Methods: We identified 27 patients at 2 centers: 14 underwent VFFT, and 13 NICT. The 2 groups were comparable for age, sex, and tumor grade. We assessed functional outcomes of the wrist with the Toronto Extremity Salvage Score, Musculoskeletal Tumor Society 1987 and 1993 scores, and Disabilities of the Arm, Shoulder, and Hand scores. Results: Two local recurrences occurred in the VFFT group and 1 in the NICT group. The VFFT group had 3 patients who had already undergone or were planning to undergo surgery for improved appearance, hardware removal, or tendon release. In the NICT group, 2 infections required debridement, one of which went on to free fibular transfer, but there were no reoperations for nonunion or donor site morbidity. The surgical time was significantly shorter for NICT. Functional scores showed no differences between groups on any of the parameters studied for the upper limb. Conclusions: Both VFFT and NICT were effective surgical techniques for wrist fusion after distal radial resection for giant cell tumor. Vascularized free fibular transfer should be considered when a major skin defect is anticipated, because it allows the inclusion of a vascularized skin paddle, or when the osseous defect is too long (> 10 cm) for NICT. We were unable to demonstrate a difference in upper limb functional scores between VFFT and NICT. Because the surgical time is significantly shorter and the reoperation rate is lower for NICT, we recommend NICT whenever possible. Type of study/level of evidence: Therapeutic III.
机译：目的：切除radius骨远端巨细胞瘤后的腕关节固定术可以使用血管化的游离腓骨转移术（VFFT）或非血管化的c骨转移术（NICT）进行。本研究的目的是比较这些手术后的联合时间，功能结局和并发症。方法：我们在2个中心确定了27位患者：14位接受了VFFT，13位进行了NICT。两组在年龄，性别和肿瘤分级方面具有可比性。我们用多伦多肢体救助评分，1987年和1993年肌肉骨骼肿瘤协会评分以及手臂，肩膀和手部残疾评分评估了腕部的功能结局。结果：VFFT组发生了两次局部复发，NICT组发生了1次局部复发。 VFFT组有3例已经接受或计划接受手术以改善外观，去除硬件或释放腱的患者。在NICT组，有2例需要清创的感染，其中1例继续游离腓骨转移，但没有因不愈合或供体部位发病而再次手术。 NICT的手术时间明显缩短。在上肢研究的任何参数上，功能评分均显示两组之间无差异。结论：VFFT和NICT均是radial骨远端远端切除术后手腕融合术的有效手术技术。当预计会出现严重的皮肤缺损时，应考虑血管化的游离腓骨转移，因为它允许包含血管化的皮瓣，或者当骨缺损对于NICT而言太长（> 10 cm）时。我们无法证明VFFT和NICT之间的上肢功能评分存在差异。由于NICT的手术时间明显缩短且再手术率较低，因此我们建议尽可能使用NICT。研究类型/证据级别：治疗III。

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