儿童长骨骨巨细胞瘤的手术效果评价

Estimation of Surgical Effect of Giant Cell Tumor of Bone in Children

目的通过对不同手术方式治疗儿童长骨骨巨细胞瘤（GCTB）的疗效分析，评价不同手术方式的疗效。方法分析1990年12月～2004年12月本院15例儿童长骨GCTB患者的术后疗效。根据Enneking外科分期系统分期：Ⅰ（Ⅰa、Ⅰb）期采用肿瘤刮除、氯化锌烧灼残腔、过氧化氢浸泡后异体植骨及病灶刮除后骨水泥填充的治疗方法；Ub期采用瘤段切除大段异体骨移植重建，术后定期随访。结果术后随访2～16年，平均7年。Ⅰ期13例。其中9例GCTB采用病灶刮除，氯化锌烧灼残腔、过氧化氢浸泡后异体植骨的方法进行治疗，无1例复发，肢体无畸形；另4例采取病灶刮除后骨水泥填充，2例复发；Ⅱb期2例采用瘤段切除大段异体骨移植重建愈合良好，无塌陷及骨折，但患肢平均短缩2cm，无移植排斥，无1例复发。结论Ⅰ（Ⅰa、Ⅰb）期GCTB，病灶刮除、氯化锌烧灼、过氧化氢浸泡后异体植骨可达满意效果，而单纯行病灶刮除后骨水泥填充效果不佳。Ⅱb期GCTB行瘤段切除虽肿瘤无复发。但会对儿童肢体发育产生影响。

Objective To estimate the effects of different surgical treatments of giant cell tumor of bone （ GCTB ） of long bone in children. Methods The effects of surgical treatment of 15 cases suffered from GCTB were observed. The tumors were rated according to the system of Enneking classification, stage Ⅰ was managed with a curettage combined with local adjuvant treatment and filled by allograft bone or with curettage and filled by cement of bone. Stage Ⅱb was treated by en bloc resection followed by reconstruction with large segment bone of allograft, The follow - up was given in all patients. Results The follow - up period was 7 years （ ranged 2 - 16 years）. In all 15 children patients with GCTB, there were 13 children in stage Ⅰ ,9 patients with curettage combined with local adjuvant treatment and allograft bone showed good bone knitting and rehabilitation without deformity and functional problem and locally recurred; 4 patients with curettage and filled by cement of bone showed 2 cases locally recurred. Two children in stage Ⅱb treated by en bloc resection followed by reconstruction with large segment bone of allograft were perfectly incorporated without evidence of obvious immune rejection, collapse, fracture and locally recurred, but the limb - suffered was short about 2 cm. Conclusions Stage Ⅰ treated by a curettage combined with local adjuvant treatment and filled by allograft bone can get good effect, but only treated by a curettage and filled by cement of bone has 50% locally recurred, The Ⅱb treated by en bloc resection followed by reconstruction with large segment bone of allograft might influence the limb growth, but without locally recurred.