骨巨细胞瘤治疗分析

Therapeutic analysis of bone giant cell tumor

目的比较不同手术方法治疗骨巨细胞瘤的临床效果。方法回顾性分析1998年11月至2008年11月手术治疗的83例四肢骨巨细胞瘤患者,男52例,女31例,其中胫骨近端26例,股骨远端28例,桡骨远端16例,肱骨近端7例,肱骨远端2例,股骨近端3例,足趾骨1例。于本院确诊时平均年龄30.3(14～53)岁,Campanacci分级:Ⅰ级45例,Ⅱ级35例,Ⅲ级3例;初发55例,复发28例,合并病理性骨折7例。Jeffer病理分级,一级35例,二级46例,三级2例。结果 83例患者均获得随访,随访时间8个月至9年2个月,平均4年11个月。病灶刮除+液氮冷冻+骨水泥填充术45例,肿瘤复发4例;病灶刮除+液氮冷冻+自体骨植骨术35例,肿瘤复发3例;瘤段骨切除人工假体置换术2例,肿瘤复发0例;瘤段骨切除煮沸灭活后回植1例,肿瘤复发0例。病灶刮除组总复发率8.75%,瘤段切除组织复发率为0。结论病灶刮除+液氮冷冻+骨水泥填充术、自体骨植骨术和肿瘤瘤段切除术均是治疗骨巨细胞瘤的可靠方法 。

Objective To evaluate the clinical effects of the giant cell tumors treated with different surgical approaches. Methods 83 patients （52 males and 31 females） with giant cell tumors in extremities treated by curettage and en block resection from November 1998 to November 2008 were analyzed retrospectively. Among them, 26 cases were in proximal tibia, 28 cases in distal femur, 16 cases in distal radius, 7 cases in proximal humerus, 2 cases in distal humerus, 3 cases in proximal femur and 1 case in phalanges foot. The average age when the diagnosis was confirmed was 30.3 years old （range; 14-53 years）. Campanacci grading： 45 cases of grade Ⅰ, 35 cases of grade Ⅱand 3 cases of grade Ⅲ. 55 cases incipient, 28 cases recurrent, and 7 cases of complicated pathological fracture. Jeffer pathological grading： 35 cases of first grade, 46 cases of second grade and 2 cases of third grade. Results All the 83 eases followed-up. The mean time of follow up was 4 years and 11 months （range; 8 months-9 years and 2 months）. 45 cases treated with curettage, devitalizing with liquid nitrogen frozen and packing with cement and 4 cases of tumor recurred. 35 cases treated with curettage, devitalizing with liquid nitrogen frozen and autologous bone transplantation and 3 cases of tumor recurred. None of 2 case treated with block resection and artificial joint prosthetic replacement recurred. None of 1 case treated with block resection and reconstructed with devitalized original tumor-bearing bone recurred. The overall recurrence rate was 8.75% in the euretted group and 0% in the block resection group. Conclusions Both curettage, devitalizing with liquid nitrogen frozen and packing with cement and autologous bone transplantation and block resection are an effective and safe method in the treatment of bone giant cell tumors.