膝关节周围骨巨细胞瘤刮除后填充骨水泥对关节软骨影响的临床研究

CLINICAL STUDIES ON EFFECT OF BONE CEMENT FILLING ON ARTICULAR CARTILAGE OF THE KNEE AFTER CURETTAGE OF GIANT CELL TUMOR

目的探讨膝关节周围骨巨细胞瘤刮除后填充骨水泥对关节软骨的影响。方法回顾分析2000年1月-2011年12月收治并符合选择标准的53例骨巨细胞瘤患者临床资料。男30例,女23例;年龄16-69岁,平均34.2岁。肿瘤累及部位：股骨远端28例,胫骨近端25例。Campanacci分级：Ⅰ级6例,Ⅱ级38例,Ⅲ级9例。其中病灶内刮除后单纯骨水泥填充42例,联合软骨下自体骨植骨及骨水泥填充11例。术后参考Aboulafia等分级系统评定患者是否继发骨关节炎并分组,比较两组性别、年龄、肿瘤部位、软骨下残留骨厚度、肿瘤大小、术前Campanacci分级、软骨下是否植骨、Enneking功能评分,并进行多因素logistic回归分析。结果术后切口均Ⅰ期愈合,无手术相关并发症发生。患者均获随访,随访时间23-158个月,平均65个月。其中37例（69.8%）无骨关节炎发生,16例（30.2%）继发骨关节炎。随访期间3例（5.7%）肿瘤局部复发。单因素logistic回归分析示,两组性别、年龄、肿瘤部位、Campanacci分级比较,差异无统计学意义（P〉0.1）;软骨下残留骨厚度、肿瘤横截面百分比、Enneking功能评分及软骨下植骨比较,差异有统计学意义（P〈0.1）。多因素logistic回归分析示软骨下残留骨厚度减小、肿瘤横截面增大、未行软骨下植骨为术后继发骨关节炎的危险因素（P〈0.05）。结论膝关节周围骨巨细胞瘤刮除后填充骨水泥会增加关节软骨的损伤,联合软骨下植骨可以延缓或减少该损伤。

Objective To evaluate the effect of bone cement filling on articular cartilage injury after curettage of giant cell tumor around the knee.Methods Fifty-three patients with giant cell tumor who accorded with the inclusion criteria were treated between January 2000 and December 2011,and the clinical data were retrospectively analyzed.There were 30 males and 23 females,aged 16-69 years（mean,34.2 years）.The lesion located at the distal femur in 28 cases and at the proximal tibia in 25 cases.According to Campanacci grade,there were 6 patients at grade I,38 at grade Ⅱ,and 9 at grade Ⅲ.Of 53 patients,42 underwent curettage followed by bone cement filling,and 11 received curettage followed by bone grafts in the subchondral bony area and bone cement filling.Two groups were divided according to whether secondary osteoarthritis occurred or not during postoperative follow-up.The gender,age,lesion site,the subchondral residual bone thickness,tumor cross section,preoperative Campanacci grade,subchondral bone graft,and Enneking function score were compared between 2 groups,and multivariate logistic regression analysis was done.Results All incisions healed by first intention.The average follow-up time was 65months（range,23-158 months）.Of 53 cases,37（69.8%） had no osteoarthritis,and 16（30.2%） had secondary osteoarthritis.Three cases（5.7%） recurred during the follow-up period.Univariate logistic regression analysis showed no significant difference in gender,age,lesion site,and Campanacci grade between 2 groups（P〉0.1）;difference was significant in the subchondral residual bone thickness,tumor cross section,Enneking function score,and subchondral bone graft（P〈0.1）.The multivariate logistic regression analysis showed that the decreased subchondral residual bone thickness,the increased tumor cross section,and no subchondral bone graft are the risk factors of postoperative secondary osteoarthritis（P〈0.05）.Conclusion Curettage of giant cell tumor around the knee followed by bone cement filling can increase the damage of cartilage,and subchondral bone graft can delay or reduce cartilage injury.