膝关节周围骨巨细胞瘤病理性骨折影像学特征研究

Radiological features about pathological fracture of giant cell tumor around the knee joint

目的比较膝关节周围骨巨细胞瘤（giantcelltumor，GCT）无病理性骨折与病理性骨折患者的影像学差异，探讨病理性骨折的影像学特征。方法2000年3月至2013年12月，天津医院、第四军医大学附属西京医院、济南军区总医院、浙江大学医学院第二附属医院、四川大学附属华西医院等国内五家骨肿瘤治疗中心的膝关节周围GCT病例91例，男40例（44．0％），女51例（56．0％）；年龄17-78岁，平均36．81岁。分为无病理性骨折组（53例）和病理性骨折组（38例）。分析两组病例影像学资料中的肿瘤体积、肿瘤到软骨下骨的距离、Campanacci分级、软组织侵袭情况及病理性骨折移位情况等指标间的差异。结果20-40岁年龄段的GCT患者所占比例最高（58．2％，53／91）。GCT位于股骨远端的比例病理性骨折组（78．9％）高于无病理性骨折组（45．3％），差异有统计学意义（χ^2=10．40，P=0．001）；病理性骨折组的肿瘤体积[（98．46±53．35）cm]大于无病理性骨折组[（63．19±34．92）cm]，差异有统计学意义（t=3．57，P=0．001）；病理性骨折组肿瘤到关节面的距离（中位数：0．145am；极差：0．46cm）小于无病理性骨折组（中位数：0．170cm；极差：1．90cm），差异有统计学意义（χ^2=2．853，P=0．004）。软组织受侵袭不同程度在病理性骨折发生率上差异有统计学意义（χ^2=11．08，P=0．004）。结论膝关节周围GcT肿瘤体积大小、肿瘤到软骨下骨的距离及软组织受侵袭程度均与病理性骨折的发生有密切关系。

Objective To compare the radiological differences of giant cell tumor （GCT） around the knee between those with pathological fracture and those without pathologic fracture and explore the radiological features of pathological fracture. Methods From March 2000 to December 2013, 91 patients with GCT around the knee from domestic five bone tumor centers were involved, including 40 males and 51 females, with an average age of 36.81 years （range, 17-78）. All patients were divided in- to non pathological fracture group （53 cases） or pathological fracture group （38 cases）. The radiological differences such as tumor volume, the distance between tumor and subchondral bone, Campanacci classification, soft tissue invasion and bone displacement were analyzed. Results GCT most frequently occurred in young adults between 20 and 40 years of age （58.2%, 53/91）, pathologi- cal fracture group with 78.9%. The proportion of tumors on the distal femur of pathological fracture group was higher than the non pathological fracture group, which showed statistical significance （χ^2=10.40, P=0.001）. The tumor volume of pathological fracture group [（98.46±53.35） cm^3] was greater than the no pathological fracture group [（63.19＋34.92） cm^3], there was statistical differ- ence between the two groups （t=3.57, P=0.001）. The distance between tumor and subchondral bone of pathological fracture group [median （M）= 0.145 cm, range （R）=0.46 cm] was lower than that non pathological fracture group （M, 0.170 cm; R, 1.90 cm）, and the difference was statistically significant （χ^2=2.853, P=0.004）. There were also significant differences in the incidence of patholog- ic fracture between the degree of soft tissue invasion （χ^2=11.08, P=0.004）. Conclusion Tumor volume, distance between tumor and subchondral bone and the dezree of soft tissue invasion are closelv related to natholozical fracture of GCT around the knee.