病灶内切除与整块切除治疗桡骨远端骨巨细胞瘤的Meta分析

Intralesional curettage and wide excision for treatment of giant cell tumors(GCTs) of the distal radius:A Meta analysis

目的 :用Meta分析的方法对国内外已发表较高质量的有关比较病灶内切除术和整块切除术对桡骨远端骨巨细胞瘤患者术后复发率、并发症发生率和功能康复结果的临床研究进行综合定量分析,为桡骨远端骨巨细胞瘤的外科治疗模式的选择提供参考依据。方法:计算机检索Cochrane图书馆(2014年8期)、Pub Med、Ovid、Elsevier、CNKI等数据库。检索从(1970-01-01/2013-01-01)年有关病灶内切除与整块切除治疗治疗桡骨远端骨巨细胞瘤的文献,筛选出符合纳入标准的文献,并对其进行严格的质量评价。利用Cochrane协作网提供的Rev Man 5.0软件对纳入研究结果进行Meta分析,并对数据进行异质性检验。计算病灶内切除术相对整块切除术其复发及并发症发生危险的优势比(OR),评价病灶内切除术与整块切除术对桡骨远端骨巨细胞瘤患者复发及并发症发生的影响。结果 :符合纳入标准的文献7篇,总样本量163例。其中病灶内切除术组92例(PMMA n=54,骨移植n=33,非PMMA或非骨移植n=5),整块切除术组71例。病灶内切除术组骨巨细胞瘤复发率比整块切除术组高[OR=3.87,95%CI(1.42,10.53)],而在Campanacci 3级GCTs中[OR=10.12,95%CI(1.57,65.27)],病灶内切除术组并发症发生率更少[OR=0.13,95%CI(0.04,0.40)],病灶内切除术组内用PMMA与骨移植物充填病灶的复发率没有明显差异[OR=0.96,95%CI(0.26,3.56)]。通过选择用MSTS系统评价、VAS系统评价和握力计系统评价时,病灶内切除术组在功能康复结果中优于整块切除组。结论:基于有限的资料,表明整块切除术更加适合治疗桡骨远端骨巨细胞瘤,而病灶内切除术在治疗桡骨远端骨巨细胞瘤的Campanacci 1、2级比3级更加适合,病灶内切除桡骨远端骨巨细胞瘤方面,PMMA并不优于骨移植物。病灶内切除桡骨远端骨巨细胞瘤在功能康复方面优于整块切除组。

Objective：To search all studies that had been published in the world with regarding to the effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complications and comparative functional outcomes in patients with giant cell tumours（GCT） of the distal radius and analyze them which were in high quality by means of Meta analysis,in order to give some evidences for the choice of method dealing with giant cell tumors GCT in surgery. Methods：Cochrane central register of controlled trials（Issue 8 2014）,Pub Med（1970-01-01 / 2013-01-01）,Ovid（1970-01-01 / 2013-01-01）,Elsevier（1970-01-01 / 2013-01-01）,CNKI（1970-01-01 / 2013-01-01） were searched. Including intralesional curettage and wide excision were performed to treat giant cell tumors（GCTs） of the distal radius in the literatures,selecting on meet eligibility in the standard literatures underwent strict quality assessment. The Meta analysis was performed with software Rev Man5.0 from the Cochrane collaboration. Additionally,the analysis checked the heterogeneity of data. The effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complication in patients with giant cell tumours of the distal radius were evaluated and Odds Ratio was calculated. Results：Seven relevant articles were identified involving total163 cases. Among them,92 cases were intralesional curettage（PMMA,n=54;bone graft,n=33;no PMMA or bone grafts,n=5）and 71 cases were wide excision. The patients in the intralesional curettage group had a higher recurrence rate [OR=3.87,95%CI（1.42,10.53）],especially for Campanacci grade 3 GCTs [OR=10.12,95%CI（1.57,65.27）],yet fewer major complications[OR=0.13,95%CI（0.04,0.40）] than the wide excision group. The use of PMMA versus bone graft did not affect the recurrence rate [OR=0.96,95%CI（0.26,3.56）]. By selecting the system evaluation of MSTS,the VAS and dynamometer,the result showed that the intralesional curettage group was equivalent or preferable to wide excision in terms of function rehabilitation.Conclusion：Based on data obtained from the limited number of studies available,intralesional curettage appears to be more appropriate for the treatment of local lesions（Grade 1 and 2） than Grade 3 GCTs of the distal radius. Moreover,PMMA was not additionally effective as an adjuvant,the intralesional curettage group was found to be equivalent or preferable to wide excision in terms of function rehabilitation.