不同手术方法对骨巨细胞瘤治疗疗效的影响

Different surgical treatments of giant cell tumor of bone

目的探讨不同手术方式对骨巨细胞瘤疗效的影响。方法 1991年1月至2005年12月我院治疗长骨骨巨细胞瘤59例。男28例,女31例。平均年龄32.5岁。刮除植骨术8例次、刮除+灭活+瘤腔内化疗+植骨术16例次、瘤段切除自体骨移植术14例次、瘤段切除人工关节置换术22例次、截肢术4例次、瘤段切除灭活再植术3例次。分析刮除+灭活+瘤腔内化疗+植骨术、瘤段切除自体骨移植术、瘤段切除人工关节置换术3种手术方式对术后复发、肢体功能、综合评定的影响。结果本组患者均获得随访,平均51(14～168)个月。术后复发7例,其中刮除植骨术3例,刮除、灭活、瘤腔内化疗、植骨术2例,瘤段切除人工关节置换术1例,瘤段切除灭活再植术1例。5种手术方式(除截肢术外)肢体功能平均得分分别为28.4、28.1、25.7、22.6、21.3。术后综合评定优良率分别为62.5%、81.3%、57.1%、54.6%、0%、33.3%。结论从降低术后复发率和保留肢体功能角度而言,刮除灭活植骨并行瘤腔内化疗是治疗骨巨细胞瘤较理想的手术方式。对于瘤段切除假体置换术应严格掌握适应证。

Objective To investigate the effect of different surgical treatment of bone giant cell tumor. Methods Between Jan. 1991 to Dec. 2005, we have treated 59 patients with long bone giant cell bone tumor, including 28 male and 31 female, with the mean age of 32.5 years. Eight patients underwent curettage and bone grafting; 16 underwent curettage, adjuvant phenol therapy, bone grafting and intralesional chemotherapy; 14 underwent en bloc resection of bone tumor with autologous bone replacement; 22 with en bloc resection of bone tumor with total joint replacement, 4 underwent amputation, and 3 underwent en bloc resection and devitatized bone reconstruction. We studied the effect of the surgical options mentioned previously in terms of postoperative recurrence, limb function and comprehensive evaluation. Resluts All patients were followed up for 14 to 168 months, with the average time of 51 months. Seven patients had postoperative recurrence （3 with curettage and bone grafting, 2 with tumor curettage,adjavant phenol therapy, bone grafting and intralesional chemotherapy, each one with en bloc resection of bone with total joint replacement and en bloc resection and replantation with inactived bone）.The average scores of the limb function of the mentioned five methods （except the amputation） are 28.4, 28.1, 25.7, 22.6, 21.3 respectively. The comprehensive postoperative excellent rates are 62.5%, 81.3%, 57.1%, 54.6 %, 0%, 33.3% respectively. Conclusions Curettage, adjuvant phenol therapy, bone grafting and intralesional chemotherapy is a better therapy for giant cell tumor of bone with the lower recurrence rate and better limb function.