复发性骨巨细胞瘤的手术治疗选择和随访结果

Treatment options for recurrent giant cell tumors of bone

[目的]探讨复发性骨巨细胞瘤（giant cell tumor of bone,GCTB）的治疗选择。[方法]回顾性分析2004-2009年本院收治的18例GCTB复发患者的治疗方法和随访结果。评价指标包括影像学评估、功能评分（MTSS评分）：〉70%满意、？70%不满意。18例患者初次复发14例、二次复发4例;股骨远端12例、胫骨近端6例、髌骨1例;Campanacci分级：2级7例,3级10例,恶变1例;采用扩大刮除＋骨水泥（内固定）,瘤段广泛切除＋肿瘤型假体重建和截肢。[结果]扩大刮除的11例患者有2例复发,行瘤段切除重建术,6例瘤段切除重建患者无复发,远处转移2例（1例恶变截肢的患者死亡）。MTSS评分〉70%12例,？70%6例。[结论]根据骨巨细胞瘤复发患者的临床和影像分级以及年龄,患者对功能的具体要求,可选择相应的手术方法。原则上局部条件允许的情况下首选刮除术;瘤段切除重建术具有病灶切除彻底、不易再次复发的优点;对于巨细胞瘤复发、恶变,软组织污染的患者可以采取截肢手术。

[Objective]To investigate the treatment options for recurrence bone giant cell tumors（GCTB）.[Method]From 2004 to 2009,a retrospective analysis was performed on the treatment methods and results of 18 patients with GCTB,with 10 male and 8 female,average age of 32 years（range,19-60 years） old.There were 14 cases of primary recurrence,4 cases of secondary recurrence.The lesion site was in distal femur in 12 cases,in proximal femur in 6 cases,in patella in 1 case.According to Campanacci classification,there were 7 cases of grade 2,10 cases of grade 3,1 case of malignant alteration.Treatment options included expand excision and bone cement in 5 cases,expand excision,bone cement and internal fixation in 3 cases,wide resection of the tumor and prosthesis reconstruction in 9 cases,amputation in 1 case.The average follow-up period was 48 months（range,6-72 months）.After operation,MTSS score system was used,and 70% was regarded as satisfactory result,≦70% as unsatisfactory result.[Result]Two cases were found recurrence in 11 expand excision patients,and received wide resection and reconstruction.No recurrence was found in 6 patients receiving tumor resection and reconstruction treatment.Two cases were found distant metastasis,in which 1 case was found malignancy and this patient died after amputation.MTSS score showed satisfactory results in 12 cases,unsatisfactory results in 6 cases.[Conclusion]Treatment options depend on different clinical and imaging classification,age,and specific requirements of function.In principle,curettage is preferred if local conditions allow.Wide resection combined with prosthesis reconstruction removes lesion completely and has lower chance of recurrence.Amputation can be adopted for those with recurrence,malignancy,soft tissue pollution and damage.