腫瘍切除後非血管柄付き遊離腓骨移植を用いて再建した橈骨遠位端骨巨細胞腫の2例

Reconstruction with Non-Vascularized Osteoarticular Fibular Graft after Excisionof Giant Cell Tumor of the Distal Radius : Report of Two Cases

　抄録：橈骨遠位端骨巨細胞腫切除後に，非血管柄付き遊離腓骨近位端を用いて手関節形成を行った2例を経験した．症例1は16歳，Campanacci分類Grade 2であった．骨癒合は6カ月で得られた．術後5年で，単純X線像上再発はなく，関節症変化を認めるが，疼痛はなく，手関節の可動域は，背屈55°，掌屈50°，握力は健側の77％で，Ennekingの患肢機能評価は96％である．症例2は52歳，Campanacci分類Grade 3であった．術後，骨接合部で骨折を起こしたが，ギプスと装具で骨癒合が得られた．骨シンチグラフィー上，移植骨への集積がみられた．術後1年4カ月で，手関節の可動域は，掌屈・背屈とも15°で，握力は健側の55％で，Ennekingの機能評価は73％である．腫瘍を一塊に切除し，遊離腓骨で再建することで，腫瘍の良好な局所コントロールと手関節機能の獲得が可能であった．橈骨遠位端の腫瘍摘出後に広範な骨欠損が生じた場合の再建方法として，簡便で有用な選択肢となりうる．

　We report two cases that were treated by en bloc resection for giant cell tumor of the distal radius, followed by reconstruction of the wrist with arthroplasty using a non-vascularized proximal fibular autograft.

　Patient 1 was a 16-year-old female whose tumor was classified as grade 2 according to the grading system of Campanacci. The patient underwent a 5-cm non-vascularized proximal fibular graft after en bloc resection of the distal radius, and bone union was achieved 6 months after surgery. Five years after the operation, radiographs demonstrated complete union, no evidence of recurrence, and minimal osteoarthritic changes in the new wrist joint, and the patient had no pain. The patient has 55° of extension, 50°of flexion, and grip strength is 27 kg, which is 77％ of that on the opposite side. According to the functional system of the Musculoskeletal Tumor Society, the involved limb scored 100％.

　Patient 2 was a 52-year-old woman whose tumor was diagnosed as Companacci grade 3. After en bloc resection of the tumor, a wrist arthoplasty was performed using a 7-cm non-vascularized proximal fibular graft. Five months after the operation, a fracture occurred at the union site, but bone union was achieved with a cast and brace. The postoperative bone scintigraphy findings indicated that the whole graft was viable. One year and 4 months after surgery, the patient has 15° of extension, 15°of flexion, and grip strength is 12kg, which is 55％of that on the uninvolved side. The function of the involved limb scored 73％. Reconstruction with a non-vascularized fibular graft after en bloc resection of the tumor facilitates favorable wrist joint function and good local control. Based on the authors' experience, this procedure is a simple and useful option for reconstruction at the bone defect after en bloc resection of tumors of the distal radius.