骨巨细胞瘤的诊断和治疗(附105例分析)

Giant cell tumor of bone: a review of diagnosis and treatment of 105 cases

目的总结骨巨细胞瘤诊断、治疗中的经验和体会，对不同手术方式的选择和效果提出评价和探讨。方法搜集并复习１０５例骨巨细胞瘤患者的资料，对照临床与Ｘ线、组织学检查的结果进行分析。对手术效果及预后进行了较长期的随访观察。结果患者主要临床特征与国内、外统计情况基本相同，本组有多发性１例及发生远处转移２例。部分病例的Ｘ线、组织学表现与临床不尽相符。刮除术组术后复发率３６％，瘤段截除组术后均无复发，但不能有效保留关节功能。结论须强调临床、影像学与病理诊断相结合的原则，争取早期诊断和手术，尽可能保留关节功能。术前应用ＤＳＡ行肿瘤血管栓塞有助于骶骨、骨盆部位手术的成功及减少复发。

Objective To summarize the experience in the diagnosis and treatment of giant cell tumor of bone, the selection of various operation methods and their effects were evaluated and discussed. Methods From 105 cases of giant cell tumor of bone data were collected and reviewed. The clinical features were analyzed in association with radiological and histological characteristics. Prognosis was assessed by long term follow up.Results Among 105 cases, one had multiple giant cell tumors and two had distant metastases. In some cases, the radiological and histological appearances didn`t accord with the clinical findings. The recurrence rate was 36% in patients treated with curettage. Although no recurrence was seen in patients treated by local excision, the joint function could not be fully retained. Conclusion Diagnosis should be made on the basis of integrated clinical, radiological and pathological manifestations. Early diagnosis and operation are important. The function of joint must be retained as much as possible. Pre operative embolization of tumor of sacrum and pelvis is very helpful to ensure operative success and to minimize recurrence.