脊柱骨巨细胞瘤手术治疗2年内复发情况及危险因素分析  

Analysis of recurrence and risk factors in surgical treatment of giant cell tumor of the spine bone within 2 years

作　　者：刘锋[1] LIU Feng(Department of Orthopedics,First People’s Hospital of Yibin, Yibin, Sichuan 644000,China)

机构地区：[1]宜宾市第一人民医院骨一科

出　　处：《颈腰痛杂志》2019年第4期498-500,504,共4页The Journal of Cervicodynia and Lumbodynia

摘　　要：目的探讨脊柱骨巨细胞瘤(giant celltumor of bone,GCTB)行手术治疗后的2年内复发情况及其危险因素。方法纳入2013年3月~2016年3月手术治疗的86例脊柱GCTB患者,随访2年以上,根据2年内是否复发设为复发组与未复发组。调查两组患者患病节段、手术方式等病历资料,采用单因素与多因素分析调查脊柱GCTB手术治疗2年内复发的独立危险因素。结果86例患者2年复发20例,复发率23.26%,平均复发时间(14.33±2.81)个月;两组患病节段、双膦酸盐使用情况、术后放疗、手术方式、胰岛素样生长因子ⅡmRNA结合蛋白3(IMP3)表达、胰岛素样生长因子2(iIGF2)表达、侵袭范围、累及节段数量、手术史、年龄等差异有统计学意义(P<0.05),术前Frankel分级、肿瘤最大直径、性别、Enneking分期、手术入路等差异无统计学意义(P>0.05);多因素logistic回归分析显示,腰椎患病(OR=2.676)、未使用双膦酸盐(OR=3.032)、次全椎节切除(OR=3.214)、IMP3阳性(OR=4.126)术后2年内复发的独立危险因素。结论脊柱GCTB手术治疗短期内具有较高的复发率,腰椎患病、未使用双膦酸盐、次全椎节切除、IMP3阳性均可能增加其复发风险。Objective To analyze the recurrence and risk factors in surgical treatment of giant cell tumor of bone (GCTB) within 2 years. Methods Eighty-six patients with spinal GCTB treated from March 2013 to March 2016 were selected as the study subjects. All patients were treated with surgery. All patients were followed up for more than 2 years. The postoperative recurrence was recorded, and the recurrence group and non-recurrence group were set according to whether recurrence occurred in 2 years. The medical records of the diseased segments and surgical Methods of the two groups were investigated. Univariate and multivariate analysis were used to investigate the independent risk factors for recurrence in 2 years after spinal GCTB surgery treatment. Results Eighty-six patients with spinal GCTB had recurrence in 20 cases within 2 years, the recurrence rate was 23.26%, and the average recurrence time was (14.33±2.81) months. Two groups of diseased segments, bisphosphonate use, postoperative radiotherapy, surgical procedure, insulin-like growth factor II mRNA binding protein 3 (IMP3) expression, insulin-like growth factor 2 (iIGF2) expression, invasion range, involvement segment and number, history of surgery, and age had statistically significant differences ( P <0.05). There were no significant differences in preoperative Frankel classification, tumor maximum diameter, gender, Enneking staging and surgical approach ( P >0.05). Multivariate logistic regression analysis showed that lumbar spine disease (OR=2.676), no bisphosphonate (OR=3.032), and subtotal sponectomy (OR=3.214), IMP3 positive (OR=4.126) were independent risk factors for recurrence within 2 years after spinal GCTB surgery treatment. Conclusion Spinal GCTB surgery has high recurrence rate in the short term. Lumbar disease, unused bisphosphonate, subtotal spondylolisthesis and IMP3 positive may increase the risk of recurrence.

关 键 词：骨巨细胞瘤 脊柱肿瘤 复发 相关因素 

分 类 号：R738.1[医药卫生—肿瘤]