肢体骨复发性骨巨细胞瘤的外科治疗

Surgical treatment against recurrent extremity giant cell tumor of bone

目的探讨肢体骨复发性骨巨细胞瘤的治疗方法及疗效。方法 2001年10月-2008年7月共收治肢体骨复发性骨巨细胞瘤23例,男14例,女9例。年龄19～52岁,平均32.2岁。股骨远端9例,胫骨近端5例,桡骨远端4例,肱骨近端3例,股骨近端2例。复发时间为术后7个月-6年4个月,平均25.7个月。根据发病部位、放射线分级选择的治疗方法为:再次刮除+骨水泥充填15例,瘤段切除+人工假体重建6例,自体腓骨重建2例。结果随访时间10个月至6年6个月,平均37.6个月。再次刮除组中2例复发(13-3%),瘤段切除组无局部复发,根据Eneeking评分标准,瘤段切除+功能重建组的肢体功能优良率达75.3%。结论囊内刮除虽仍存在再次复发的风险,但可较完好的保留关节功能,应作为治疗的首选。对Companacci Ⅲ级的肢体骨复发性骨巨细胞瘤采用瘤段切除与功能重建治疗可有效地降低局部复发率,近期疗效满意。

Objective To investigate the method and efficacy in the treatment of recurrent extremity giant cell tumor of bone. Methods Between October 2001 and July 2008, a total of 23 patients （14 males, 9 females） with recurrent extremity giant cell tumor of bone were treated in our hospital. The mean age was 32.2years （range, 19-52years）. The lesion was located in distal femur （n-9）, in proximal tibia （n 5）, in distal radius （n-4）, in proximal humerus （n-3）, and ill proximal femur （n-2）. The mean recurrent time was 25.7months （range, 7-76months） post- operatively. According to the lesion and classification of radioactive ray, all the patients were divided into 3 groups, group A, group B and group C. Group A （n=15） was treated with re-curettage and bone cement filling, group B （n-6） with tumor resection and prosthe：ic reconstruction, and group C （n 2） with auto-fibula reconstruction. Results The average follow-up was 37.6 months （range, 10-78months）. Group A reported 2 recurrent cases （13.3%）, and group B had no local recurrence. According to the Eneeking scoring system, the excellent and good rate of group B and group C reached 75.3%. Conclusions Re-curettage should be considered to be the first option, in that it can reserve the joint function relatively completely, despite of potential recurrent risks. With respect to the recurrent extremity giant cell tumor of bone being Companacci grade Ill, tumor resection and reconstruction of function can effectively reduce the local recurrence and have good recent results.