四肢骨巨细胞瘤的手术治疗  

Surgical Therapy for Giant Cell Tumor of Long Bones

作　　者：张涛[1] 张余[1] 徐亮[1] 黄华扬[1] 尹庆水[1] 吴峰[1] 张德春[1] 王庆[1] 

机构地区：[1]广州军区广州总医院全军创伤骨科中心,广东广州510010

出　　处：《实用骨科杂志》2011年第10期899-901,953,共4页Journal of Practical Orthopaedics

摘　　要：目的比较不同手术方法治疗四肢骨巨细胞瘤的疗效。方法自1998年5月至2006年5月收治骨巨细胞瘤48例,男28例,女20例;年龄16～59岁,平均31岁。股骨远端19例,胫骨近端18例,股骨近端5例,肱骨近端5例,肱骨远端1例。按Campanacci分级,Ⅰ级7例,Ⅱ级30例,Ⅲ级11例。根据肿瘤部位、Campanacci分级及患者年龄,采取不同的手术治疗方法,其中单纯刮除植骨或骨水泥填充17例,刮除植骨内固定19例,瘤段切除+人工关节置换12例。结果随访时间3～11年,平均6.8年,刮除植骨组有4例复发,复发率为11.1%,瘤段切除+关节置换组有1例复发,复发率为8.3%,术后患者Enneking功能评定优25例,良12例,可6例,差5例,总体满意率为89.6%。结论病灶刮除植骨是骨巨细胞瘤基本的外科治疗方法,局部辅助处理措施如高速磨钻磨削、蒸馏水浸泡可达到安全的外科治疗边界,从而大大降低病灶刮除术后的复发率,且术后肢体具有良好的功能;瘤段切除适用于CampanacciⅢ级骨巨细胞瘤,虽复发率较低,但重建后的并发症相对较多。Objective To evaluate the clinical results of the giant cell tumors of long bones treated with different surgical procedures.Methods 48 patients with giant cell tumors in extreme ities who were treated with operation from May 1998 to May 2006 were reviewed.There were 28malesand 20 females with the mean age of 31 years old（16～59 years）.The anatomic site for the lesions were the distal femur（19 cases）,proximal tibia（18 cases）,proximal femur（5 cases）,proximal humerus（5 cases）,distal humerus（1 case）.Using Campanacci staging system：7 cases were classified as gradeⅠ,30 as grade Ⅱ,11 as grade Ⅲ.17 cases had been performed tumor curettage with bone graft or cementation,19 cases received internal fixation with bone graft curettage,enblock excision and reconstruction by endoprostheses were done for 12 cases.Results The mean follow-up time was 6.8（3～11）years.the recurrence rate was 4 cases（11.1%） in group of cases with tumor curettage,and 1 case（8.3%） with joint replacement.Using Enneking functional evaluation：excellent in 25 cases,good in 12 cases,six cases can be,and poor in 5 cases,the overall satisfaction rate of 89.6%.Conclusion Curetting and bone graft are still the elemental surgical therapies to treat the giant cell tumor of bone.Adjunctive treatment such as high speed grinding and Distilled water immersion could reduce recurrence rate.And has a good limb function;Enblock excision is indicated in patients who were classified as Campanacci Ⅲ.The recurrence rate is low in this group,however there are many complications.

关 键 词：骨巨细胞瘤 手术 刮除术 置换 

分 类 号：R738.1[医药卫生—肿瘤]