邻膝关节骨巨细胞瘤手术治疗的中长期随访及预后相关因素分析

Correlation analysis of surgical treatment outcomes of giant cell tumor close to the knee with mid-term and long-term folow up

为了探讨邻膝关节骨巨细胞瘤的临床特点、肿瘤切除方式及预后相关因素分析,手术治疗54例邻膝关节骨巨细胞瘤,45例采用病损内手术,9例采用大块切除重建(异体关节移植或人工关节置换)。根据随访结果比较两组患者的肿瘤复发、肢体功能和术后并发症。采用Logistic回归方法对可能影响其预后的8种因素进行分析。结果:两组Enneking功能评分结果比较,差异有统计学意义,t=4.03,P=0.005;两组间术后局部复发比较,差异无统计学意义,χ2=0.76,P=0.648;两组术后并发症发生率差异有统计学意义,χ2=14.65,P=0.00。术后肿瘤复发与患者Jaffe组织病理学分级(γ=-2.272,P=0.036)、手术术方式(γ=3.578,P=0.002)呈相关关系。初步研究结果提示,手术方式是影响邻膝关节骨巨细胞瘤预后的最重要因素;可以根据CT横截面及肿瘤破坏大小,分别选择病损内手术和肿瘤大块切除重建,而有效的病损内手术是邻膝关节骨巨细胞瘤外科治疗的首选。

The objective of this study was to retrospectively study the clinical characteristics, resection mode and outcomes of giant cell tumor close to the knee. A retrospective analysis was performed in 54 patients who underwent surgical treatment for giant cell tumor close to the knee. There were 45 cases had been managed with curettage, heat cauterization with electrocautery and phenol, autograft and cement, 9 cases with a semi-arthroplasty using allograft or arthroplasty using prosthetic after en bloc resection. According to the relation of the clinical signs and symptoms, tumor character,operative method and local recurrence, limp function, complication were evaluated. There were statistical difference in Enneking Score （t= 4.03, P= 0.005） and the rate of complication （X^2=14. 65,P=0.00） be tween 2 groups. The rate of the local recurrence between 2 groups showed no statistical difference, X^2 =0.76, P= 0.648. The operative modes （γ=3. 578, P=0.002） and histologicgrading （γ=-2.272, P=0.036） are related fac tors of the recurrence of bone giant cell tumor. In conclusion, the choice strategy of surgical treatment for giant cell tumor close to the knee should be based on the figure of tumor lesion on CT. It gives a new formulation of treatment to choice of an intralesional procedure and en bloc resection. An effective intralesional procedure should be the method of the first choice.