股骨近端骨巨细胞瘤GTOC临床评分系统有效性分析  

Effectiveness analysis of GTOC clinical scoring system for giant cell tumor of bone in the proximal femur

作　　者：宋加诗 金凯鹏 姚全 吕战虎 刘兵[2] SONG Jiashi;JIN Kaipeng;YAO Quan(Zhejiang Rongjun Hospital,Zhejiang 314000,China)

机构地区：[1]浙江省荣军医院,嘉兴314000 [2]浙江大学医学院附属第二医院 [3]新疆生产建设兵团第一师医院

出　　处：《浙江创伤外科》2024年第6期1009-1013,1016,共6页Zhejiang Journal of Traumatic Surgery

基　　金：国家自然科学基金资助项目(81872181);浙江省自然科学基金资助项目(LY21H160034)。

摘　　要：目的回顾性分析股骨近端骨巨细胞瘤患者的手术方式,验证GTOC临床评分系统的有效性。方法2011年1月至2022年12月,共收集浙江大学医学院附属第二医院股骨近端骨巨细胞瘤患者45例,根据中国骨巨细胞瘤协作组成成员(Member of the Chinese Association for Giant Cell tumor of Bone,GTOC)临床评分系统进行评分,统计分析GTOC临床评分系统与手术方式、术后并发症、下肢功能的关系,采用MSTS93下肢功能评分系统评估患肢术后功能,分析影响股骨近端骨巨细胞瘤手术方式选择的因素,对扩大刮除术与大段切除术进行对比分析,从而验证GTOC临床评分系统的有效性。结果45例患者随访时间12~86个月,平均25.7个月。共出现13例并发症,总的发生率28.9%,复发2例,总复发率为4.4%。单因素及多因素Cox回归分析显示影响手术方式选择的因素是病理性骨折和病变部位(P<0.05)。统计资料分析显示,高分组与低分组的手术方式差异有统计学意义(χ^(2)=8.557,P<0.05),呈正相关关系(Pearson相关系数R=0.436,P=0.003)。对扩大刮除术与瘤段切除重建术进行对比分析,两种手术方式的术后MSTS功能评分、手术时间有明显差异(P<0.05)。结论GTOC临床评分系统涵盖了手术方式选择的主要影响因素,对于股骨近端骨巨细胞瘤患者在临床治疗手术方案的选择中具有指导价值。Objective This retrospective study analyzed surgical procedures for patients with giant cell tumor of bone at the proximal femur and validated the effectiveness of the GTOC clinical scoring system.Methods From January 2011 to December 2022,a total of 45 patients with proximal femoral giant cell tumor of bone in our hospital were collected.Score was performed according to GTOC clinical scoring system,and the relationship between GTOC clinical scoring system and operation mode,postoperative complications and lower limb function was statistically analyzed.The Musculoskeletal Tumor Society(MSTS)score was used to evaluate the limb salvage function of the patients.Factors influencing the selection of surgical methods for giant cell tumor of proximal femur were analyzed,and extended curettage and large segment resection were compared to verify the effectiveness of the GTOC clinical scoring system.Results The 45 patients were followed up for 12 to 86 months(mean 25.7 months).A total of 13 complications occurred,with a total incidence of 28.9%and 2 relapses,with a total recurrence rate of 4.4%.Univariate and multivariate Cox regression analysis showed that pathological fracture and lesion site were the main factors influencing the choice of surgical method(P<0.05).Statistical analysis showed that there was a significant difference in surgical methods between the high group and the low group(χ^(2)=8.557,P<0.05),and there was a positive correlation(Pearson correlation coefficient R=0.436,P=0.003).There were significant differences in MSTS function scores and operative time between extended curettage and segmental resection(P<0.05).Conclusion The GTOC clinical scoring system covers the factors influencing the choice of surgical mode,and has guiding value for the selection of clinical treatment and surgical plan for patients with proximal femoral giant cell tumor of bone.

关 键 词：股骨近端骨巨细胞瘤 GTOC临床评分系统 手术方案选择 

分 类 号：R687.3[医药卫生—骨科学]