膝关节周围骨巨细胞瘤治疗的多中心回顾性研究  

Surgical treatment of giant cell tumor of bone around the knee： a multicenter retrospective study

作　　者：王晗[1] 胡永成[2] 于秀淳[4] 王臻[3] 吴苏稼[5] 叶招明[6] 万宁军[1] 徐明[4] 朱皓东[3] 林秾[6] 胡波[5] 袁斌斌[2] 

机构地区：[1]天津医科大学研究生院,300070 [2]天津市天津医院骨肿瘤科 [3]第四军医大学西京医院骨肿瘤科 [4]济南军区总医院骨病科 [5]南京军区总医院骨科 [6]浙江大学医学院附属第二医院骨科

出　　处：《中华骨科杂志》2012年第11期1040-1047,共8页Chinese Journal of Orthopaedics

基　　金：基金项目：天津市自然科学基金（12JCYBJC16400）,天津市卫生局科技基金（2011KY24）

摘　　要：目的回顾性分析多中心膝关节周围骨巨细胞瘤的治疗现状，探讨影响手术方案选择、肿瘤复发以及肢体功能的相关危险因素。方法收集5个骨肿瘤治疗中心2000年3月至2012年5月病理学确诊并经手术治疗的222例膝关节周围骨巨细胞瘤患者，男120例，女102例；年龄（35．5-12．3）岁。肿瘤行囊内刮除术、切刮除术或边缘切除术。分析流行病学、形态学、影像学因素和临床特征，探索术后肿瘤复发、手术方式、术后肢体功能的相关影响因素。结果行囊内刮除128例（57．6％），切刮除术13例（5．8％），边缘切除术79例（35．5％）。159例患者获得随访，随访率为71．6％。术后23例复发，复发率14．5％（23／159），术后至复发的时间（23．9±22．3）个月。囊内刮除术后复发率为19．0％，切刮除术为0，边缘切除术为8．9％，手术方式是影响术后复发的唯一因素。复发肿瘤的手术方式与首诊原发肿瘤的差异有统计学意义，复发患者更倾向于边缘切除。病理性骨折、Campanacci分级、Enneking骨肿瘤分期以及有无软组织肿块可明显影响手术方式的选择。囊内刮除术后患者的国际骨肿瘤协会（Musculoskeletal Tumor Society，MSTS）评分明显优于边缘切除，Enneking分期、有无软组织肿块、首诊原复发亦可明显影响患者术后肢体功能。结论手术切除方式是同时影响术后复发与肢体功能的唯一因素。Objective To retrospectively analyze treatment status quo of giant cell tumor of bone around the knee in several institutes, and to investigate risk factors affecting selection of surgical manners, tumor recurrence, and functional outcomes. Methods A total of 222 patients with giant cell tumor of bone around the knee confirmed by pathology, who had undergone surgical treatment in 5 institutes from March 2000 to May 2012, were enrolled in this study. There were 120 males and 102 females, with an average age of 35.5 years. The epidemiology, clinical and radiographic features and risk factors affecting selection of surgical manners, tumor recurrence, and functional outcomes were analyzed. Results Intralesional curettage was performed in 128 patients（57.6%）, intralesional curettage combined with partial resection in 13 patients （5.8%）, and marginal excision in 79 patients （35.5%）. A total of 159 patients were followed up. The local recurrence rate was 19.0% for patients treated with intralesional curettage, 8.9% for marginal excision and 0% for intralesional curettage combined with partial resection, and the total local recurrence rate was 14.5% （23/159）. The mean duration from primary operation to recurrence was 23.9 months. Univariate analysis indi- cated that surgical manner was the only factor affecting local recurrence. Pathological fracture, Campanacci grades, Enneking system as well as soft tissue mass had a significant influence on the selection of surgical manners. The mean MSTS score after intralesional curettage was obviously higher than that after marginal excision. Conclusion The surgical manner is the only factor affecting local recurrence and limb function.

关 键 词：膝关节 巨细胞瘤 骨 预后 多中心研究 

分 类 号：R738.1[医药卫生—肿瘤]