两种不同微波灭活技术在肢体骨巨细胞瘤治疗中的比较

The comparison of 2 different microwave ablation techniques in treatments for giant cell tumor of the extremity

目的回顾性分析两种不同的微波灭活技术应用于肢体骨巨细胞瘤的手术方法,观察手术疗效,从而找出一种更加安全有效的应用微波治疗肢体骨巨细胞瘤的手术方法。方法 2006年9月至2010年9月,21例肢体骨巨细胞瘤的患者在我院接受手术治疗,其中原发病例18例,复发3例(均为局部复发,未发现远处转移)。病变部位股骨8例,胫骨5例,肱骨5例,桡骨2例,尺骨1例。肿瘤伴发病理性骨折3例。8例行肿瘤原位微波灭活刮除术,即先行肿瘤原位微波灭活后刮除肿瘤;13例行肿瘤囊内刮除微波辅助残腔灭活术,即先采用常规的方法刮除肿瘤后,辅助以微波灭活肿瘤刮除术后的残腔。全部病例均得到病理学证实。结果全部患者均得到随访,平均随访时间23个月。各有1例肿瘤微波原位灭活刮除及肿瘤刮除微波辅助残腔灭活的病例,术后10个月及18个月局部复发。2例股骨远端病例及1例胫骨近端病例在术后6-12个月内发生骨折,均为肿瘤原位微波灭活刮除病例。无伤口并发症及深部感染的发生,无远处转移。术后MSTS功能评分微波原位灭活刮除组平均为24分,囊内刮除辅助微波灭活组平均为28分,全部微波灭活治疗的病例平均为26分。结论微波灭活技术是一种有效的治疗肢体骨巨细胞瘤的手术方法,可以获得较满意的术后局部复发率。肿瘤囊内刮除微波辅助残腔灭活术在保持局部低复发率的基础上,进一步降低了微波灭活术后骨折的发生率。

Objective To explore a more effective and safer operative method to treat giant cell tumor in the extremity with microwaves through analyzing 2 different microwave ablation techniques in treatments for giant cell tumor in the extremity and observing the surgical outcomes retrospectively. Methods From September 2006 to September 2010, 21 patients with giant cell tumor in the extremity underwent surgical treatment in our hospital. There were 18 cases of primary lesions, and 3 cases of recurrent lesions that all recurred locally without distant metastasis. The lesion locations： 8 cases in the femur, 5 cases in the tibia, 5 cases in the humerus, 2 cases in the radius and 1 case in the ulna. 3 pathological fractures were found due to tumors. 8 patients were treated with in situ microwave ablation and curettage, in which tumors were ablated before curettage. 13 patients were treated with intralesional curettage and microwave-assisted ablation of the residual cavity, in which tumors were curetted using traditional method, and then the residual cavity was ablated assisting with microwaves after curettage. All cases were confirmed pathologically. Results All patients were followed up for an average period of 23 months. Local recurrence occurred in 1 case of in situ microwave ablation and curettage 10 months after surgery and 1 case of curettage and microwave-assisted ablation of the residual cavity 18 months after surgery. Distal femoral fractures happened in 2 cases and proximal tibial fractures happened in 1 case within 6-12 months after surgery, which were all cases of in situ microwave ablation and curettage. No wound complication and deep infection occurred. No distant metastasis was found. The average Musculoskeletal Tumor Society （MSTS） function score was 24 points in in situ microwave ablation and curettage group and 28 points in intralesional curettage assisting with microwave ablation group. The average score of all cases of microwave ablation was 26 points. Conclusions The microwave ablation technique is an effective operative method for giant cell tumor in the extremity with low local recurrence rates after surgery. The intralesional curettage and microwave-assisted ablation of the residual cavity further reduce the incidence of fractures after microwave ablation on the basis of low local recurrence rate.