病灶刮除骨水泥填充术与病段切除术治疗肢体骨巨细胞瘤的中长期随访研究  

Middle-long follow-up of curettage with cementation or en-bloc in the treatment of giant cell tumors of limb bone

作　　者：韦永中[1] 李菊明[1] 马益民[1] 许晶晶[1] 

机构地区：[1]南京医科大学第一附属医院骨科,江苏南京210029

出　　处：《中国肿瘤外科杂志》2017年第2期77-80,共4页Chinese Journal of Surgical Oncology

摘　　要：目的探讨肢体骨巨细胞瘤病灶刮除骨水泥填充治疗的疗效,并与病段切除术的疗效进行比较。方法 2003—2012年南京医科大学第一附属医院确诊的骨巨细胞瘤37例,男18例,女19例;年龄17~67岁,平均年龄35岁。病变部位位于股骨远端12例,股骨近端2例,胫骨近端8例,胫骨远端2例,桡骨远端6例,肱骨近端3例,腓骨近端4例。按照Campanacci分级:Ⅱ级15例,Ⅲ级22例。治疗方法:病灶刮除骨水泥填充或加内固定16例;病段切除21例,其中病段切除加肿瘤型人工关节置换13例。结果随访4~12年,平均随访6年。病灶刮除骨水泥填充组复发3例,复发率18.8%;病段切除组复发2例,复发率9.5%(均为软组织内复发);两组复发率比较,差异无统计学意义(P>0.05)。并发症随访:病灶刮除骨水泥填充组术后7年发生骨关节炎1例,未予特殊处理;病段切除组肿瘤假体重建组分别于术后5年、12年因松动返修各1例。骨与软组织肿瘤协会功能评分:骨水泥填充组平均评分为28分,病段切除组为22分。功能评定优良29例,中差8例,其中病灶刮除骨水泥填充组优良率为93.8%,病段切除组的优良率为66.7%。结论病灶刮除骨水泥填充是肢体骨巨细胞瘤治疗的有效方法,彻底清除病灶是降低复发率的关键。对于CampanacciⅢ级合并病理性不稳定骨折者可选择病段切除或加假体重建,应注意假体相关并发症。Objective This study aimed to investigate the local outcomes and complications after aggressive curettage compared to the outcomes after en bloc resection. Methods A retrospective analysis was performed with giant cell tumor （GCT） of bone that presented to the authors＇ institution between 2003 and 2012. This study comprised 37 patients, including 18 males and 19 females. The age of the patients ranged from 17 to 67 years with a mean age of 35 years. Anatomical locations included distal femur （12 cases）, proximafemu （2）, proximal tibia （ 8 ）, distal tibia （ 2 ）, proximal humerus （ 3 ）, distal radius （ 6 ）, and proxima fibula （4）. According to Campanacci staging, there were 15 cases in grade Ⅱ, 22 in grade Ⅲ. The 37 patients were divided into two groups, 16 patients were treated with aggressive curettage and cavity filling cementation with/without internal fixation. The rest 21 patients were managed with resection, and 13 of them underwent endoprosthetic reconstruction. Results The average follow-up was 6 years, ranging from 4 to 12 years. Three pa- tients （18. 8% ） developed local recurrence in the curettage group and 2 patients （9. 5%, both in the soft tissues） in the resection group. There were no significant differences in recurrence rate between the two groups （P 〉 0. 05）. One patient had osteoarthritis 7 years after curettage, and no special treatment was taken. The major eomplieation was aseptic loosening of tumor prostheses in the 5 years （ 1 case） and 12 year （ 1 ease） after resection, and they were all successfully revised. Mean Musculoskeletal Tumor Society score （MSTS） of the curetrage group was higher than that of the resection group. Functional assessment results showed that 29 patients were excellent/good, 8 were medium/poor. The excellent rate of the curettage group wax 93.8% , and the excellent rate was 66. 7% in patients with tumor resection and joint replaeemenl. Conclusions l,oeal aggressive curettage with cementation is an effectiv

关 键 词：骨巨细胞瘤 外科手术 刮除术 骨水泥成形术 随访研究 

分 类 号：R738.1[医药卫生—肿瘤]