瘤体骨切除灭活再植治疗四肢长骨巨细胞瘤

Treatment of Gaint Cell Tumor of Long Bones by Replantation of Resected Bone After Decitalization

体内刮除及灭活植骨治疗骨巨细胞瘤（ＧＣＴ）的复发率高。我科从１９８６年６月～１９９６年２月治疗四肢长骨ＧＣＴ２４例。随访１１个月～８年４个月。其中７例采用局部切刮体内灭活植骨和（或）骨水泥充填治疗。结果１例感染，６例复发，１例恶变后死于肺转移。作者自１９９１年１月采用瘤体骨切除，离体灭活再植，与骨残端体内灭活相结合，骨缺损采用自家腓、髂骨移植，Ｌ－梯形加压钢板（Ｌ－ＴＣＰ）或梯形加压钢板（ＴＣＰ）固定治疗１７例，其中１２例保留关节，５例做膝关节融合。本组无菌创口感染１例，１例复发。在保留关节的１２例中９例关节功能恢复优良，１例尚可，２例差。充分说明瘤段骨切除体外灭活再植术疗效确实，复发率低。保留关节术式适于关节破坏较轻（＜＝１／２）者，结合关节残端体内灭活和有效的骨结构重建，有利于恢复关节功能。如关节面累及＞１／２，宜做骨关节端切除，灭活再植，下肢宜做关节融合或人工关节置换术。

The recurrent rate of GCT after curettage and devitalization in vivo was still very high. From June 1986 to February 1996, 24 patients with GCT of long bone were treated and followed-up for 11 months to 8 years and 4 months. Of those, 6 were treated with curettage and devitalization in vivo. The bone defect was repaired by bone graft and /or bone cement. The results showed that wound infection developed in one and recurrence occured in 6. One of them converted from grade Ⅱ to Ⅲ and died of metastasis. Since January 1991, 17 patients with GCT have been treated by tumor bone resection and replantation after curettage and devitalizaing in 75% of alcohol. The bone defect was reparied with autogenous fibular and iliac bone graft and fixed with L-compression plate (L-TCP). The joint was preserved in 12 cases, and arthrodesis was performed in 5 cases. Wound infection developed in one case.Recurrence ocurred in one case. The functions of the joint rated excellent and good in nine, fair in one and poor in two. The results demonstrated that the replantation of tumor bone after devitalization in vitro was more reliable.The recurrent rate was much lower.The joint can be preserved in those when the articular surface involved less than 1/2.