瘤体刮除术和瘤大块切除术用于膝关节周围骨巨细胞瘤的疗效观察

Surgical management results of curettage and en bloc resection of tumors for treatment of giant cell tumor of the bone around the knees

[目的]比较观察瘤体刮除术和瘤大块切除术两种肿瘤切除方式用于膝关节周围骨巨细胞瘤的疗效,探讨膝关节周围骨巨细胞瘤的临床特点和肿瘤切除方式对预后的影响。[方法]根据肿瘤部位和破坏大小分别选择瘤体刮除术和瘤大块切除术两种手术方法治疗43例膝关节周围骨巨细胞瘤,35例采用瘤体刮除植骨术,8例采用瘤大块切除重建术(人工关节置换、大块异体骨移植)。随访比较观察两组患者的术后并发症、肿瘤复发、肢体功能等疗效情况。[结果]两组术后并发症发生率,差异有显著统计学意义,P<0.01;两组Enneking骨骼肌肉肿瘤术后功能评分结果比较,差异有显著统计学意义,P<0.01;两组间术后局部肿瘤复发率,差异无统计学意义,P>0.05;肿瘤复发与Jaffe组织病理学分级和X线Campanacci分期呈正相关系,P<0.05。[结论]对膝关节周围骨巨细胞瘤应根据肿瘤部位及其破坏的程度,分别选择瘤体刮除术或瘤大块切除术,而瘤体刮除术如能有效切除肿瘤又不影响骨支撑作用应作为膝关节周围骨巨细胞瘤外科治疗的首选手术方式。

[Objective]To evaluate the effectiveness of curettage and en bloc resection of tumors for treatment of bone giant cell tumor around the knees.[Methods]Forty-three patients with bone giant cell tumor around the knees were treated,including 35 patients who underwent surgical treatment for intralesional excision（curettage） of the tumors and 8 patients for en bloc resection.A retrospective analysis was performed in the patients.The complication,locals recurrence,limb function of the two operative methods were evaluated.[Results]There were significant difference in the complication rate（P0.01） and Enneking Scores（P0.01） between the 2 groups.There were no statistical differences in the rate of the local recurrence between the 2 groups（P0.05）.There were statistical difference between the Jaffe histologic grading and the recurrence of bone giant cell tumor（P0.05）.[Conclusion]The selection of curettage or en bloc resection for treatment of giant cell tumor around the knees should be based on the clinical characteristics and the lesion site and severity.If curettage can offer a complete excision of the tumor and no influence on the bone support,it should be the first choice.