胫骨远端骨巨细胞瘤手术术式的选择12例报告并文献复习  

Surgical strategy of giant cell tumor of the distal tibia-a multi-center research and systematic review of 12 cases

作　　者：徐明 王丰 于秀淳 胡永成[2] 张国川[3] 郑凯 XU Ming;WANG Feng;YU Xiu-chun;HU Yong-cheng;ZHANG Guo-chuan;ZHENG Kai(Department of Orthopedics,The 960th Hospital of PLA,Jinan,Shandong,250031,China)

机构地区：[1]解放军第960医院骨科,济南250031 [2]天津市天津医院骨肿瘤科,300211 [3]河北医科大学第三医院骨肿瘤科,石家庄050051

出　　处：《中国骨与关节杂志》2021年第8期582-591,共10页Chinese Journal of Bone and Joint

摘　　要：目的通过对多中心及文献报道的胫骨远端骨巨细胞瘤(giant cell tumor of bone,GCT)的临床治疗疗效进行分析,探讨胫骨远端GCT手术方式选择的策略。方法回顾分析2000年1月至2017年12月,解放军第960医院、天津医院、河北医科大学第三医院所收治的12例胫骨远端GCT患者,男4例,女8例。年龄20~64岁,平均34岁。初诊时原发11例,复发1例。Capanacci分级:Ⅱ级5例和Ⅲ级7例。手术方式及例数:刮除术5例,其中骨水泥填充3例,自体骨植入1例,同种异体骨植入1例(购自山西奥瑞生物材料有限公司,批号:2003ED231001);切刮术6例,其中骨水泥填充4例,自体骨植入2例;整块切除术1例,重建方式为自体腓骨髂骨植骨、可吸收螺钉固定、踝关节融合。处理瘤壁的辅助措施有:电刀烧灼10例,电动磨钻6例,微波5例,苯酚1例。选用胫骨远端GCT相关的检索词检索外文及中文数据库,对检索文献进行系统分析,指标包括流行病学特征、手术方式、手术疗效及疗效比较。结果本组12例随访28~177个月,复发3例(复发率27.2%,其中1例肺转移)。12例MSTS评分43.3%~100.0%,平均88.1%。检索胫骨远端GCT相关文献,筛选出13篇文献,共61例,男24例,女28例,另9例性别未描述。年龄25~50岁,平均33岁,另8例年龄未描述。Campanacci分级:Ⅰ级3例,Ⅱ级22例,Ⅲ级26例,10例未描述。手术方式及例数:刮除术24例,切刮术13例,整块切除术24例。处理瘤壁的辅助措施有:苯酚4例,过氧化氢3例,液氮1例。骨缺损修复方式:植骨30例,骨搬运13例,骨水泥填充11例,假体置换5例,钽块植入1例。随访12~229个月,刮除术组5例复发,复发率为21%;切刮术组4例复发,复发率为31%;整块切除术组1例复发,复发率为4%。术后复发率,三种术式差异无统计学意义(P=0.073)。踝关节非融合组与融合组术后MSTS评分,差异有统计学意义(P=0.000)。结论保留踝关节的刮除术和切刮术是治疗胫骨远端GCT的首选�Objective To explore the surgical strategy of giant cell tumor of the distal tibia based on a multi-center review and literature report. Methods A retrospective analysis of 12 patients with giant cell tumor of the distal tibia (treated in The 960 th Hospital, Tianjin Hospital, The Third Hospital of Hebei Medical University) were conducted from January 2000 to December 2017, including 4 males and 8 females with an average of 34 years (range: 20-64 years). At the initial diagnosis, 11 cases were primary and 1 relapsed. Capanacci classification: 5 cases of grades Ⅱ and 7 cases of Ⅲ. Operation methods and cases: 5 cases of curettage, including 3 cases of bone cement filling, 1 case of autogenous bone implantation and 1 case of allogeneic bone implantation;6 cases of curettage combined with resection, including 4 cases of bone cement filling and 2 cases of autologous bone implantation;1 case after En bloc resection was reconstructed with autofibular ilium bone graft, absorbable screw fixation and ankle fusion. Assisted measures: burn by electric knife in 10 cases, drill in 6 cases, inactivated by microwave in 5 cases, phenol in 1 case. Terms related to the GCT of the distal tibia were used to search the databases home and abroad. Observational indicators included epidemiological characteristics, surgical methods, surgical efficacy and comparison of efficacy. Results In this group, 12 patients with GCT of the distal tibia were followed up for 28-177 months, and 3 patients recurred (recurrence rate 27.2%;1 of them had lung metastasis). MSTS of 12 patients ranged from 43.3% to 100.0%, with an average of 88.1%. A total of 61 patients were selected from 13 literatures related to distal tibial GCT. There were 24 males and 28 females, and the gender of the other 9 patients was not described. The average age was 33 years (range: 25-50 years), while the other 8 patients were not described. Campanacci classification: 3 cases of grade Ⅰ, 22 cases of grade Ⅱ, 26 cases of grade Ⅲ, 10 cases not described. Surgical methods

关 键 词：骨巨细胞瘤 胫骨 刮除术 骨移植 矫形外科手术 系统综述 

分 类 号：R738.1[医药卫生—肿瘤]