四肢骨巨细胞瘤伴病理性骨折的外科治疗及并发症  

Surgical management and complications of the giant cell tumor in limbs with pathological fracture

作　　者：文立 乔军[2] 孟凡青[3] 王冬梅[4] 陈骏[3] 陈亭亭[3] 王雪迪 王守丰[2] WEN li;QIAO Jun;MENG Fanqing;WANG Dongmei;CHEN Jun;CHEN Tingting;WANG Xuedi;WANG Shoufeng(Nanjing Drum Tower Hospital Clinical College,Nanjing Medical University,Nanjing 210008,China;Department of Orthopaedics,Nanjing Drum Tower Hospital/the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Pathology,Nanjing Drum Tower Hospital/the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China;Department of Radiology,Nanjing Drum Tower Hospital/the Affiliated Hospital of Nanjing University Medical School,Nanjing 210008,China)

机构地区：[1]南京医科大学鼓楼临床医学院,江苏南京210008 [2]南京大学医学院附属鼓楼医院骨科,江苏南京210008 [3]南京大学医学院附属鼓楼医院病理科,江苏南京210008 [4]南京大学医学院附属鼓楼医院放射科,江苏南京210008

出　　处：《中国肿瘤外科杂志》2020年第5期401-406,共6页Chinese Journal of Surgical Oncology

基　　金：江苏省卫健委高层次人才“六个一工程”拔尖人才项目(LGY2019003);北京市希思科临床肿瘤学研究基金会项目(Y-HR2018-231)。

摘　　要：目的探讨四肢骨巨细胞瘤(GCTB)伴病理性骨折的外科治疗及并发症。方法对南京大学医学院附属鼓楼医院2009年1月至2019年9月收治的12例四肢长骨骨巨细胞瘤伴发病理性骨折患者的治疗以及术后并发症、随访、功能评估等临床资料进行回顾性分析。结果12例中发生关节外、关节内骨折各6例。12例一期行肿瘤刮除植骨或骨水泥填充内固定术;其中1例在一期手术后,经地诺单抗治疗,二期行刮除植骨骨水泥填充内固定术。术后随访1~119(35.0±22.5)个月,无复发病例,MSTS评分20~30(27.0±4.2)分。10例无近远期并发症,骨折愈合;2例骨折未愈合行翻修术,其中1例行扩大切除人工髋关节假体重建术,另1例行扩大切除人工膝关节肿瘤型假体重建术。2例患者翻修术后分别随访2个月和5个月,功能评分分别为28分及26分。无局部复发。结论四肢GCTB伴病理性骨折可行一期手术,选择肿瘤刮除植骨或骨水泥填充内固定术,术后功能良好。对于肿瘤巨大,骨质破坏明显的病理性骨折患者,如果能够保留关节,可选择二期手术。对于骨折不愈合或缺损较大、一期手术后畸形及功能障碍者可考虑行扩大切除假体重建术。Objective To investigate the surgical procedures and complications in the management of giant cell tumor of bone(GCTB)with pathologic fracture.Methods One hundred and ninety-six patients with GCTB were treated in our hospital from January 2009 to September 2019.The clinical data of twelve patients who suffered from fracture in joint will be analyzed retrospectively including therapeutic regimen,postoperative complications,functional assessment.Nine cases were diagnosed as primary GCTB with pathological fracture.3 cases were detected recurrence of GCTB with pathological fracture.The lesions located in distal femur of 7 cases,proximal tibia of 2 cases,proximal humerus of 2 cases,and proximal femur of one case.Surgical revisions were performed for two patients who suffered from the failure of first surgery.Results Eleven patients were treated with one-stage surgery.And one patient was treated with two-stage surgery.The average follow-up was 35.0±22.5 months(1-119 months).No local relapse rate occurred.The average MSTS function score was 27.0±4.2 points(20-30 points).Ten patients had no short-term or long-term complications.Two patients were managed with revision surgery.One patient suffered from GCTB in proximal femur with pathological fracture without cure because of large defect of bone in the femoral neck even after curettage,autografting and internal fixation.The other patient suffered from GCTB with pathological fracture in the distal femur.Varus deformity,low function and pain of the knee were found because of disrupt of cruciate ligament originafter curettage,allografting,cementation and internal fixation.This patient was given revision surgery with wide resection and knee endoprosthesis reconstruction.These two patients were followed up for two and five months respectively after revision surgery withthe MSTS score of 28 and 26 respectively.Conclusions One-stage surgery may be a good option for treatment of GCTB with pathological fracture.The curettage,bone grafting or cementation with adjuvant management w

关 键 词：骨巨细胞瘤 病理性骨折 外科治疗 并发症 

分 类 号：R738.1[医药卫生—肿瘤]