三种手术方式治疗四肢骨巨细胞瘤的临床疗效  

Clinical efficacy of three operation methods in treatment of giant cell tumor of bone in limbs

作　　者：徐强[1] 李家祥[1] 吴晓东[1] 魏巍[1] 韩冬煦 XU Qiang;LI Jiaxiang;WU Xiaodong(Department of Orthopaedics,Xuzhou Central Hospital, Xuzhou 221009,CHINA)

机构地区：[1]徐州市中心医院骨科,江苏221009

出　　处：《江苏医药》2019年第1期28-31,共4页Jiangsu Medical Journal

摘　　要：目的比较三种手术方式治疗四肢骨巨细胞瘤患者的临床疗效。方法 41例四肢骨巨细胞瘤患者分为三组:A组18例,行病灶刮除植骨术;B组13例,行病灶刮除骨水泥填充术;C组10例,行瘤段切除联合肿瘤假体重建术。比较三组术后复发、转移及并发症发生情况,并采用Enneking评分评价患肢功能。结果A、B、C组术后复发率分别为22.2%、30.8%、10.0%(P>0.05),转移率分别为5.6%、0、10.0%(P>0.05)。A组和B组均未发生切口感染、切口愈合不良、异体骨排斥及骨水泥反应等并发症,C组1例患者出现切口感染合并假体周围慢性炎症。末次随访时,A组和B组Enneking评分高于C组[(25.72±3.36)分和(25.08±3.10)分vs.(20.00±2.50)分](P<0.05),而A组与B组Enneking评分比较差异无统计学意义(P>0.05)。结论刮除术安全性高、并发症少且功能预后较好,是治疗骨巨细胞瘤的首选术式;但对于肿瘤较大或难以彻底刮除的患者,瘤段切除联合肿瘤假体重建为保肢提供了一种良好方法。Objective To compare the clinical efficacy of three operation methods in the treatment of giant cell tumor of bone in the limbs.Methods Forty-one patients with giant cell tumor of bone in the limbs were treated with bone grafting reconstruction(group A,18 cases),tumor curettage with cement reconstruction(group B,13 cases)or enbloc resection with endoprosthesis reconstruction(group C,10 cases),respectively.The recurrence,metastasis and complications were recorded,and the function of the limbs was evaluated by Enneking scoring system.Results The recurrence rates in groups of A,B and C were 22.2%,30.8% and 10.0%,and the metastasis rates were 5.6%,0 and 10.0%,respectively(P>0.05).The wound infection,poor wound healing,allograft rejection and cement reaction were not found in groups of A and B,while the wound infection complicated with periprosthetic inflammation was seen in one case of group C.The Enneking score in the final follow-up was higher in groups of A and B than that in group C [(25.72±3.36)points and(25.08±3.10)points vs.(20.00±2.50)points](P<0.05).There was no statistical difference in the Enneking score between groups of A and B(P>0.05).Conclusion Because of higher security,less complications and better functional outcomes,tumor curettage is the preferred surgical approach for the patients with giant cell tumor of bone.But for the patients with large-size tumors and difficult curette,enbloc resection with endoprosthesis reconstruction may be a good choice for limb salvage.

关 键 词：骨巨细胞瘤 刮除术 瘤段切除 

分 类 号：R738[医药卫生—肿瘤]