不同术式治疗四肢大关节部位骨巨细胞瘤疗效分析

Outcome analysis of surgical treatment for periarticular giant cell tumors

[目的]比较四肢大关节部位骨巨细胞瘤不同手术方法对肢体功能、局部复发及并发症的影响。[方法]分析1998年1月～2005年11月间共43例有完整随访资料的四肢近大关节部位骨巨细胞瘤病例。其中男22例,女21例;年龄15～51岁,平均30.6岁。Campanacci分级:Ⅰ级1例,Ⅱ级28例,Ⅲ级14例。[结果]43例患者随访时间为15～108个月,平均50个月,总复发率为9.4%。刮除植骨复发率为11.7%,并发症发生率为10.5%;广泛切除组复发率为9.1%,并发症发生率为33.3%。[结论]病灶刮除植骨仍是骨巨细胞瘤基本的外科治疗方法,局部辅助处理措施如高速磨钻磨削、石炭酸等化学腐蚀剂局部烧灼可达到安全的外科治疗边界,从而大大降低病灶刮除术后的复发率;广泛切除适用于CompanacciⅢ级、反复复发、伴有病理性骨折的病例,虽复发率较低,但重建后的并发症相对较多;加强随访可早期发现骨巨细胞瘤复发。

[ Objective] To evaluate the functional outcome and recurrence rate and complications of the giant cell tumor treated with different methods. [ Method ] Forty-three patients with giant cell tumors of extremities who were treated with operation from 1998 to 2005 were reviewed retrospectively. There were 22 males and 21 females with the mean age of 30. 6 years old （ 15 -51 years）. Using Campanacci＇s staging system： 1 case was classified as grade 1, 28 as grade Ⅱ , 14 as grade Ⅲ. All follow-up data were finished. [ Result] The mean follow-up time was 50 （ 15 - 108 ） months. The overall recurrence rate was 9. 4%. In the curetted group the recurrence rate was 11.7% and complication rate was 10. 5%. In the en block resection group the recurrence rate was 9. 1% and complication rate was 33.3%. [ Conclusion] Curetting and bone graft are still the elemental surgical therapies to treat the giant cell tumor of bone. Adjunctive treatment such as high speed grinding and carbolic acid cauterization could reduce recurrence rate. Wide excision is indicated in patients who were classified as Campanaeei＇s Ⅲ or recurred repeatedly and those with pathological fractures. The recurrence rate is low in this group, however there are many complications. To enhance the follow-up tragedy is the basic method to reveal early recurrence of the giant cell tumor.