病损内处置与整块切除治疗邻膝关节骨巨细胞瘤的比较观察

Intralesional Procedure Compared with en Bloc Resection for Giant Cell Tumor Close to the Knee

目的：研究病理Ⅰ、Ⅱ级，Ｘ线表现为ＣａｍｐａｎａｃｃｉⅡ、Ⅲ期的邻膝关节骨巨细胞瘤的治疗。方法：从１９７８～１９９３年住院治疗的骨巨细胞瘤１０３例中，选择肿瘤部位、Ｘ线分期、病理分级及随访时间相仿的病损内处置（刮除、液氮冷冻并自体或异体植骨、或骨水泥填充）患者４１例（３例有病理性骨折）；整块切除后用异体半关节移植３０例（２例有病理性骨折）进行回顾性分析。结果：显示两组间局部复发率无统计学差异，而病损内处置的术后并发症，再手术率及肢体远期功能评分均明显好于整块切除组。结论：有效的病损内处置仍应作为此类邻膝关节骨巨细胞瘤的首选治疗方法，即使诊断时伴有病理性骨折者亦然。

objective:To study the management of giant cell tumor close to the knee of Campanacci Stage Ⅱ、Ⅲ and pathologic grading Ⅰ、Ⅱ.Method:Among the 103 cases of giant cell tumor that were hospitalized between 1978 and 1993,41 cases(3 patients with pathological fracture)managed with an intralesional procedure of the tumor (curettage,freezing with liquid nitrogen and autografting or allografting,or with adjunctive local insertion of methylmethacrylate)and 30 cases (2 patients with pathological fracture)with a semiarthroplasty replacement using allograft after en bloc resection in similar site of tumor,radiographic stage,histological grade and follow up duiation were chosen for a retrospective analysis.Result:The rate of local recurrence between these two groups showed no statistical difference.There were less complication rate and reoperation rate,and better functional results after the intralesional procedure than following the en bloc resection.Conclusion:An effective intralesional procedure should be the method of first choice for management of these giant cell tumors close to the knee,even with pathological fracture at diagnosis.