长骨骨巨细胞瘤复发相关因素分析及外科治疗

Related Factors and Treating of Recurrent Giant Cell Tumor of Bone by Microwave Ablation Hyperthermia

目的：分析四肢长骨骨巨细胞瘤相关复发因素,并探讨微波消融、瘤段截除肿瘤假体置换及大段异体骨移植等方法治疗复发性骨巨细胞瘤的疗效.方法：回顾分析65例复发性骨巨细胞瘤患者的一般资料,包括性别、年龄、肿瘤部位、Campanicci＇s放射线分级、Jaffe＇s病理分级、病理骨折与否、首次手术方式选择,总结相关复发因素.并对应用微波消融、瘤段截除肿瘤假体置换及大段异体骨移植等方法治疗的复发病例进行肿瘤学及功能学评价.结果：本组收治65例复发性骨巨细胞瘤患者,男40例,女25例,年龄16～56岁,平均31.9岁.胫骨近端25例,股骨远端18例.首次Campanicci＇s放射线分级：Ⅰ级7例,Ⅱ级45例,Ⅲ级13例.Jaffe＇s病理分级结果50例与首次手术无差别.37例首次手术时影像学存在局部病理性骨折.65例首次手术方式均为局部瘤内刮除,其中32例行肿瘤残腔烧灼或浸泡处理.53例行微波灭活病灶刮除植骨重建术,术后4例复发（复发率7.5％）,再次手术后治愈.53例行微波治疗患者术后肢体功能评价,43例为优,8例为良,2例为中.Eneeking评分为25～30分（平均27.4分）.6例瘤段截除患者中,2例行瘤段截除肿瘤假体置换,4例行瘤段截除大段异体骨移植,肢体功能评价,1例为优,4例为良,1例为中.结论：影像学分级较高的病例,肿瘤复发风险明显增加;首次手术采用囊内刮除术但肿瘤刮除不彻底是肿瘤复发的最重要原因.微波消融高温治疗复发性骨巨细胞瘤复发率较低,肢体功能较好.

Objective To analyze the factors related to the recurrent giant cell tumor（GCT） of bone,and evaluate the effectiveness of microwave ablation Hyperthermia technology.Methods Totally 65 cases of recurrent giant cell tumor of long bone were analyzed.Methods of primary operation,location of tumor,presence of pathological fracture,grade of tumor according to the Jaffe＇s and the Campanicci＇s classification were reviewed.There were 53 cases were treated with microwave ablation technology to evaluate the effectiveness.Results The 65 patients included 40 males and 25 females,with the average age 31.9 years and ranging from 16 to 56 years.There were 20 recurrent tumors located at the proximal tibia and 18 cases located at the distal femur.According to Campanicci ＇s radiographic grading,there were 7 cases of Grade Ⅰ tumors,45 cases of Grade Ⅱ tumors and 13 cases of Grade Ⅲ tumors.According to Jaffe＇s pathological grade,in all recurrent GCT as compared with the primary tumors,50 cases showed no change.In all recurrence GCT cases performed with intralesional excision or curetage,37cases had pathological fractures and 32 cases were treated with adjuvant treatments in the first operation.There were 53 cases were treated with microwave ablation Hyperthermia technology and 4 cases recurred with the recurrence rate of 7.5％.The reserved function of limbs and joints was excellent in 43 eases and fine in 8 cases.Eneeking score was between 25 and 30 points,with an average of 27.4 points.Conclusion Microwave ablation hyperthermia technology could decrease the rate of tumor recurrence and get excellent function of limb and joint.