膝关节周围骨巨细胞瘤的外科治疗进展

Progress of surgical treatment on giant cell tumor of bone around the knee

骨巨细胞瘤是一种具有局部侵袭性及溶骨性的交界性原发骨肿瘤,股骨远端及胫骨近端是最常见发生部位。该病好发于20~40岁人群,患者常主诉患肢疼痛、肿胀、无法负重。手术是治疗膝关节周围骨巨细胞瘤的主要手段,常见手术方式包括病灶内刮除及广泛切除。单纯病灶内刮除术后复发风险较高,联合各种辅助处理可有效降低术后复发率;广泛切除术后复发风险较低,但膝关节功能较差且并发症发生率增加。近年来涌现出许多针对该疾病的治疗方式,包括开发新型瘤腔填充材料、设计3D打印或个性化假体对瘤性骨缺损重建等。常用全身药物如双膦酸盐和地舒单抗的应用也为骨巨细胞瘤的治疗打开了新的局面。目前膝关节周围骨巨细胞瘤仍是骨肿瘤领域的研究热点,本文就其外科治疗现状进行综述。

Giant cell tumor of bone is one of borderline bone tumors with aggressive and osteolytic activity most commonly affecting the distal femur and proximal tibia.It occurs in individuals of 20-40 years old.Patients usually present with pain,swelling and inability to bear weight on the involved extremity.Surgery is the main treatment for giant cell tumor of bone around the knee.The common surgical methods include curettage and wide resection.The risk of recurrence after curettage alone is high,which can be effectively reduced when combined with various auxiliary means.Extensive resection guarantees lower recurrence rate but leads to postoperative complications and functional losses.With the development of medicine,novel methods have emerged in recent years,including the new materials for tumor cavity filling and the design of 3D printing or custom prostheses for tumor defects reconstructing.The applications of bisphosphonates and denosumab also open a new prospect for the treatment of giant cell tumor of bone.At present,giant cell tumor of bone around the knee is still a research hotspot in the field of bone tumor.In this article the current situation of surgical treatment of giant cell tumor of bone around the knee was reviewed.