Denosumab治疗膝周复发骨巨细胞瘤术后评价  

Postoperative Evaluation of Recurrent Bone Giant Cell Tumor in Knee Treated with Denosumab

作　　者：李勇[1] 张剑锋[1] 闫明[1] 安毅[1] 王乐[1] 王辉[1] 刘洪涛[1] 王保苍[1] Li Yong;Zhang Jianfeng;Yan Ming(Department of Osteopathy,The Second Hospital of Tangshan,Tangshan 063000,China)

机构地区：[1]唐山市第二医院骨病科,河北唐山063000

出　　处：《实用骨科杂志》2020年第7期591-595,共5页Journal of Practical Orthopaedics

基　　金：2020年度河北省医学科学研究课题计划(20201452)。

摘　　要：目的探讨应用Denosumab治疗膝关节周围复发性骨巨细胞瘤后手术方式的选择。方法回顾性分析2014年2月至2019年12月经Denosumab治疗且有完整资料的膝关节周围复发性骨巨细胞瘤患者22例,男性9例,女性13例;年龄18~55岁,平均年龄(34.09±11.62)岁;股骨远端11例,胫骨近端11例。22例术前均接受3个月Denosumab治疗,首月第1、8、15、29天皮下注射120 mg,接下来120 mg/月。按照手术方式不同分为两组,刮除骨水泥填充组(12例,股骨远端7例,胫骨近端5例)首先取出前次手术内固定、骨水泥或填充骨,再次行病灶囊内刮除骨水泥填充术,必要时行内固定术;肿瘤假体置换组(10例,股骨远端4例,胫骨近端6例)采用广泛切除特制肿瘤假体置换术。术后随访通过X线、CT、MRI及局部超声,观察肿瘤局部复发情况;应用肌肉骨骼肿瘤学会(musculoskeletal tumor society,MSTS)评分对术后3个月患肢功能进行评价。结果本组22例患者随访时间12~48个月,平均随访时间(26.77±9.19)个月。两组病例总复发率为13.64%(3/22)。刮除骨水泥填充组术后3例复发(股骨远端2例,胫骨近端1例),复发率25.00%(3/12),复发时间分别为3个月、4个月、6个月,术后伤口均Ⅰ期愈合,未出现手术相关并发症。肿瘤假体置换组术后复发率0(0/10),1例术后1周出现患肢腘静脉及静脉血栓,经溶栓治疗2周后血栓消失。1例术后伤口出现脂肪液化,给与清创、缝合后愈合。未出现假体松动、脱位等相关并发症。22例患者术后3个月进行MSTS功能评分,刮除骨水泥填充组MSTS评分(28.17±1.11)分,肿瘤假体置换组MSTS评分(26.70±0.95)分。刮除骨水泥填充组MSTS评分高于肿瘤假体置换组,差异有统计学意义(P<0.05)。结论Denosumab是复发性骨巨细胞瘤的有效辅助治疗手段,停药后肿瘤复发风险高。复发性骨巨细胞瘤经Denosumab治疗后,为降低局部复发风险,建议行广泛切除肿瘤假体置换术,术后Objective To explore the surgical methods after treatment of recurrent bone giant cell tumor with Denosumab.Methods From February 2014 to December 2019,22 patients(9 males,13 females,11 distal femur,11 proximal tibia)with recurrent bone giant cell tumor of the knee were treated with Denosumab in our department.Theaverage age was(34.09±11.62)years(18~55 years).22 patients received 3 months of treatment with Denosumab(subcutaneous injection of 120 mg/times on 1,8,15,29 day and followed by 120 mg/month).22 patients were divided into 2 groups according to surgical methods.12 Patients underwent Intracapsular curettageandbone cement filling and internal fixation in group 1(7 cases of distal femur and 5 cases of proximal tibia).10 Patients underwent wide excision and prosthesis replacement in group 2(4 cases of distal femur and 6 cases of proximal tibia).Postoperative patients were followed up by DR,CT,MRI and local ultrasound.To observe the local recurrence of tumor,the function of the limb was evaluated using the MSTS score of the Musculoskeletal Tumor Society after operation and in three months after operation.Results There was no significant difference in the basic data of 22 patients.22 patients were followed up from 12 months to 48 months with anaverage follow-up of(26.77±9.19)months.The total recurrence rate of the two groups was 13.64%(3/22).There were 3 recurrent cases in group 1(2 cases of distal femur and 1 case of proximal tibia).The recurrence rate in group 1 was 25.00%(3/12).All the postoperative wounds healed in stage I,and there were no surgical complications.There were no recurrent cases in group 2.The recurrence rate in group 2 was 0(0/10).One patient had vein thrombosis in popliteal vein in one week after operation.But thrombus disappeared after 2 weeks of thrombolysis.1 patient's wound had fat liquefaction.The wound had healed with debridement and suture.There were no related complications such as loosening and dislocation of prosthesis.The MSTS in Group 1 score was(28.17±1.11)and that in Group 2

关 键 词：复发性骨巨细胞瘤 地诺单抗 刮除术 广泛切除术 

分 类 号：R738.1[医药卫生—肿瘤]