股骨近端巨细胞瘤的诊断和手术治疗

Giant cell tumor of the proximal femur:diagnosis and surgical outcomes

[目的]探讨股骨近端巨细胞瘤患者的影像学表现特点和病灶刮除同种异体植骨内固定手术的疗效。[方法]2000～2010年本科共收治并随访股骨近端巨细胞瘤患者11例。男7例,女4例;年龄17～44岁,平均28.9岁。Campanacci’s分级:Ⅰ级5例,Ⅱ级5例,Ⅲ级1例(合并病理性骨折)。Campanacci’s分级为III级的患者行肿瘤广泛切除人工髋关节置换术,其他患者均行肿瘤病灶刮除同种异体松质骨移植锁定钢板内固定手术。[结果]本组病例术后髋关节疼痛均完全消退,所有患者术后均经病理证实为巨细胞瘤。术后随访时间24～72个月,平均42个月。随访期间1例Campanacci’sⅡ级的患者在术后24个月时肿瘤复发,未出现其他术后并发症。[结论]股骨近端巨细胞瘤影像学表现往往缺少典型的偏心性和膨胀性改变,穿刺活检成功率也不高,诊断具有一定难度。病灶刮除同种异体松质骨移植锁定钢板内固定手术是治疗股骨近端巨细胞瘤安全有效的术式。术中用高频电刀反复烧灼残腔骨壁有助于消灭残留的肿瘤细胞,而移植的松质骨愈合后可提供良好的远期功能学预后。

[Objective]To review the experience with imaging characteristic of giant cell tumor（GCT） of the proximal femur and to evaluate the surgical procedure and effectiveness of lesion curettage and bone allografts followed by internal fixation.[Methods]Between 2000 and 2010,10 cases of GCT of the proximal femur underwent lesion curettage and allogenic cancellous bone graft combined with locking plate internal fixation and another one case of Campanacci＇ s Grade Ⅲ GCT received wide resection and reconstruction using total hip arthroplasty.There were 7 males and 4 females with a mean age of 28.9 years（range,17-44 years） with Campanacci＇ s Grade Ⅰ（n= 5）,Grade Ⅱ（n= 5）,and Grade Ⅲ（n=1）.[Results]Immediate relief of pain was observed post-operatively in all patients.Histopathology reported all the lesions as GCT.The patients were followed up for a mean of 42 months（range,24~72 months）.One case of Campanacci＇ s Grade Ⅱ GCT had local recurrence 24 months later,while no other complication was encountered in the follow-up period.[Conclusion]GCTs of the proximal femur usually does not show an eccentric location or expanded contour on plain radiographs and CT films,thus posing diagnostic challenges.Lesion curettage supplemented by allogenic cancellous bone graft and combined locking plate internal fixation is a safe and effective treatment for GCT of the proximal femur.The effect of high-frequency electrotome on residual cavity wall will help to eliminate remained tumor cells after curettage.Fused allogenic cancellous bone graft can provide good long-term functional outcome.