骨巨细胞瘤临床评分系统的建立及临床验证

Construction of clinical score system of giant cell tumors and clinical verification

目的 根据骨巨细胞瘤的数字化三维形态学特征,创建骨巨细胞瘤临床评分系统并进行临床验证.方法 选取2006年1月至2010年3月收治的临床随访及影像学资料完整的膝关节周围骨巨细胞瘤患者16例,男6例,女10例;年龄19～54岁,平均28.5岁.股骨远端9例,胫骨近端7例.将患者的多层螺旋CT薄层扫描原始数据导人数字化骨科临床研究平台系统（Superlmage Orthopedics Edition 1.1）,采用三维表面重建和容积重建法对骨巨细胞瘤的三维形态学特征进行观察、测量.内容包括是否伴发病理性骨折、骨皮质是否被破坏、肿瘤体积测量、关节面破坏面积百分比、肿瘤与关节面的距离.对上述指标进行分级并赋予一定的分值,建立评分系统.根据评分系统对临床病例进行评分,观察评分与手术方案、重建方案选择的关系.结果 将根据骨巨细胞瘤的数字化三维形态学特征创建的骨肿瘤临床评分系统命名为Hu-Chen Giant Cell Tumor Scale,简称HC骨巨细胞瘤评分系统,满分为12分.临床病例中采用肿瘤广泛切除辅以肿瘤假体置换患者的HC评分均≥9分,术后国际骨与软组织肿瘤协会（Musculoskeletal Tumor Society,MSTS）评分平均27分,无复发;采用肿瘤囊内刮除辅以结构性植骨患者的HC评分为6～8分,术后MSTS评分平均29分,1例复发（HC评分为8分）;采用肿瘤囊内切除辅以异体或自体颗粒性植骨患者的HC评分均＜6分,术后MSTS评分平均30分,无复发.结论 基于数字化技术的HC骨巨细胞瘤临床评分系统涵盖了影响骨巨细胞瘤治疗方案选择的主要因素,在肿瘤切除及重建方法的选择中有一定的指导作用.

Objective To establish a clinical score system of giant cell tumors （GCT） according to its morphological features presented on three-dimensional （3D） computed tomographic imaging. Methods Sixteen patients with GCT around knee were included from January 2006 to March 2009. Of the tumors, 9 were located in the distal part of femur, and 7 were in proximal part of tibia. Each patient was exposed to spiral CT preoperatively. Then these primitive CT dates were inputted into digital Orthopedics clinical research platform. With 3D surfaces reconstruction and volume rendering, we reconstructed 3D morphology of GCT. The measurement index included pathological fracture, the degree of involvement of cortical bone, the volume of tumor, the distance between tumor and joint surface and the percentage of involvement areas of articular surface. On account of previous literature and above data, clinical score system of GCT was established. Its feasibility was testified by clinical data. Results A new clinical score system of GCT was established. It was named Hu-Chen Giant Cell Tumor Scale. Full score of the system was 12. In the 16 patients, 5patients whose points was more than 9 elevated by Hu-Chen Giant Cell Tumor Scale preoperatively were treated by wide excision and prosthetic replacement. The postoperative average MSTS score of 5 patients was 27, and there were no recurrence. The 5 patients whose points was 6-8 elevated by Hu-Chen Scale were treated by intralesional excision and structured allograft. The postoperative average MSTS score of the patients was 29, and 1 case underwent recurrence whose points was 8. The 6 patients whose points were less than 6 elevated by Hu-Chen Scale were treated by intralesional excision and morsellized allograft. The postoperative average MSTS score of the patients was 27, and there were no recurrence. Conclusion Hu-Chen Giant Cell Tumor Scale established based on digital techniques includes lots of factors which determined surgical strategy. The grating system is an effectively, reliable method in treatment of GCT.