四肢骨巨细胞瘤合并病理性骨折的治疗进展  

Progress in the treatment of giant cell tumors of extremities with pathological fracture

作　　者：么文淏 范道洋 蒋协远 刘巍峰 Yao Wenhao;Fan Daoyang;Jiang Xieyuan;Liu Weifeng(Department of Orthopedic Oncology Surgery,Beijing Jishuitan Hospital,Capital Medical University,National Center for Orthopedics,Peking University Fourth Clinical Medical College,Beijing100035,China;Beijing lishuitan Orthopedic Robot Engineering Research Center Co.,Ltd,Beijing100035,China)

机构地区：[1]首都医科大学附属北京积水潭医院骨肿瘤科国家骨科医学中心北京大学第四临床医学院,北京100035 [2]北京积水潭骨科机器人工程研究中心有限公司,北京100035

出　　处：《中华外科杂志》2025年第1期81-85,共5页Chinese Journal of Surgery

基　　金：国家重点研发计划(2023YFB4706300,2021YFC2400500);北京市自然科学基金(L212042)。

摘　　要：骨巨细胞瘤(GCTB)是一种常见的具有局部侵袭性的交界性原发骨肿瘤。GCTB合并病理性骨折的临床治疗十分困难,常见手术方式为扩大刮除术和整块切除术,核因子κB受体活化因子配体(RANKL)抑制剂和双膦酸盐等药物治疗也具有一定效果。对于CampanacciⅡ级或仅限局部软组织侵犯的CampanacciⅢ级、骨结构完整的患者,推荐行刮除术;广泛软组织侵犯的CampanacciⅢ级或骨结构不完整的复杂骨折,可考虑行切除术;无法手术的患者或复杂骨折患者实施切除术前,可使用RANKL抑制剂如地舒单抗进行治疗。本文总结了四肢GCTB合并病理性骨折的常见治疗方式,分析了不同临床情况下手术方式的选择,以期为临床提供诊疗思路。Giant cell tumor of bone(GCTB)is a common locally aggressive junctional primary bone tumor,whose clinical treatment becomes more difficult once combined with pathological fracture.Extended curettage and en-bloc resection are common surgical procedures for treating GCTB,and drugs such as receptor activator of nuclear factor-κB ligand(RANKL)inhibitors and bisphosphonates have been successfully used.Curettage is recommended for patients with CampanaccigradeⅡor CampanaccigradeⅢwith localized soft tissue invasion only and simple fractures with intact bone structure.Resection may be considered for CampanaccigradeⅢwith extensive soft tissue invasion or complex fractures with incomplete bone structure.RANKL inhibitors such as denosumab may be recommended if surgery is not possible or before performing resection.This article summarizes the common treatment modalities of pathological fractures combined with giant cell tumors of extremities,including the current status of surgical and pharmacological treatments,analyzing the choice of surgical modalities in different clinical situations,in order to provide clinical inspirations for diagnosis and treatment.

关 键 词：巨细胞瘤 骨 骨折 病理性骨折 治疗 四肢 

分 类 号：R738.1[医药卫生—肿瘤]