肢体长骨骨巨细胞瘤个体化外科治疗的中长期临床结果分析  

Long-term clinical results of surgical treatment in 178 cases of giant cell tumor of limb long bone

作　　者：白锐[1] 赵振群[1] 刘艳成[2] 赵伟[1] 孙超[1] 冯卫[1] 薛慧琴[1] 王玉鑫[1] 胡永成[2] 郭世炳[1] Bai Rui;Zhao Zhenqun;Liu Yancheng;Zhao Wei;Sun Chao;Fen Wei;Xue Huiqin;Wang Yuxing;Hu Yongcheng;Guo Shibing(Department of Orthopedics,the Second Affiliated Hospital of Inner Mongolia Medical University,Hohehot 010030,China;Department of Bone Tumor,Tianjin Hospital,Tianjin 300210,China)

机构地区：[1]内蒙古医科大学第二附属医院骨科,呼和浩特010030 [2]天津医院骨与软组织肿瘤科,天津300211

出　　处：《中华解剖与临床杂志》2021年第3期305-313,共9页Chinese Journal of Anatomy and Clinics

摘　　要：目的对比个体化改良与常规方案治疗肢体长骨骨巨细胞瘤(GCTB)的临床效果,评估个体化改良方案的可行性。方法回顾性研究。纳入2005年1月—2017年12月内蒙古医科大学第二附属医院和天津医院两个骨肿瘤中心178例手术治疗的四肢长骨GCTB患者的临床资料,男95例、女83例,年龄8~75(35.7±11.7)岁。178例中,2005年1月—2011年12月70例患者设为常规组,其中男39例、女31例,年龄8~68岁,55例采用病灶内常规刮除加骨水泥、异体骨或自体骨填充,15例瘤段切除人工假体重建术;2012年1月—2017年12月108例患者设为改良组,其中男56例、女52例,年龄16~75岁,根据肿瘤发生的部位、Campanacci分级、病理骨折与否,采用95例改进的病灶内磨削术加骨水泥和或异体骨或自体骨填充,13例瘤段切除人工假体(膝关节为改进假体)重建等个体化改良方案。观察并对比两组术后并发症情况、术后复发转移情况及5年累积无复发生存率;末次随访时采用国际骨与软组织肿瘤协会(MSTS)评分标准比较术后两组患者肢体功能。结果178例患者均顺利完成手术。两组基线资料比较差异均无统计学意义(P值均>0.05)。所有患者术后随访24~117(56.9±26.1)个月。(1)术后有15例患者出现并发症,常规组11例(15.7%,11/70)、改良组4例(3.7%,4/108),常规组患者并发症发生率明显高于改良组,主要发生于瘤段切除关节重建患者,差异有统计学意义(χ^(2)=7.939,P<0.05)。(2)178例患者中,24例(13.5%)复发。常规组和改良组术后总体复发率分别为22.9%(16/70)和7.4%(8/108),差异有统计学意义(χ^(2)=8.691,P<0.05)。常规组中病灶内常规刮除术患者的复发率为27.3%(15/55),改良组中病灶内扩大刮除术患者的复发率为7.4%(7/95),差异有统计学意义(χ^(2)=11.027,P<0.05);两组瘤段切除重建术患者分别有1例复发,差异无统计学意义(P>0.05)。患者的总复发率13.5%(24/178),其中桡骨远端和股骨�Objective To compare the effectiveness of individualized modified and conventional therapies in the treatment of the giant cell tumor of the long bone of extremities and evaluate the feasibility of the individualized modified regimen.Methods The clinical data of patients with long-bone giant cell tumour of bone(GCTB)of extremities treated by surgery in the Second Affiliated Hospital of Inner Mongolia Medical University and two bone tumor centers of Tianjin Hospital from January 2005 to December 2017 were included.A total of 95 males and 83 females aged 8-75(35.7±11.7)years were included.From January 2005 to December 2011,70 cases(39 males and 31 females aged 8-68 years)were treated with routine curettage,bone cement,allogeneic bone or autogenous bone filling,and tumor segment resection and artificial prosthesis reconstruction,which were divided into routine group.From January 2012 to December 2017,according to the location of tumor,Campanacci grade,pathological fracture,modified intralesional grinding with bone cement and or allogeneic bone or autogenous bone filling,and tumor segment resection and artificial prosthesis(knee joint improved prosthesis)reconstruction were divided into individualized improved scheme group(improved group),56 males and 52 females,aged 16-75 years.The observation indicators were as follows:postoperative complications,postoperative recurrence and metastasis and 5-year cumulative relapse-free survival rate between the two groups,and the International Musculoskeletal Tumor Society(MSTS)score at the last follow-up to compare the limb functions of the two groups after surgery.Results All patients completed the operation successfully.No significant difference was observed in the baseline data of the two groups(all P values>0.05).All patients were followed up for 24-117(56.9±26.1)months.(1)In this study,there were 15 patients with postoperative complications,including 11 patients in the routine group(15.7%,11/70)and 4 patients in the improved group(3.7%,4/108),were observed.The incidence of

关 键 词：骨巨细胞瘤 复发 临床结果 肿瘤治疗方案 肱骨 股骨 胫骨 

分 类 号：R738.1[医药卫生—肿瘤]