肿瘤型膝关节假体置换治疗胫骨近端骨巨细胞瘤多中心回顾性研究

Endoprosthetic replacement of the proximal tibia for giant cell tumor of bone: a multicenter retrospective study

目的探讨肿瘤型膝关节假体置换术治疗胫骨近端骨巨细胞瘤的临床效果。方法回顾性分析2000年6月至2014年2月,全国7个骨肿瘤治疗中心应用肿瘤型膝关节假体置换术治疗的76例胫骨近端骨巨细胞瘤患者,男32例,女44例;首诊时平均年龄(38±6.8)岁。原发49例中Campanacci Ⅱ级13例,Ⅲ级36例;复发27例中Campanacci Ⅱ级5例,Ⅲ级22例。根据肿瘤的范围,行胫骨近端肿瘤整块切除,采用旋转铰链型人工膝关节置换。均采用腓肠肌内侧头肌瓣转移覆盖假体,髌韧带止点与假体固定装置以及翻转的腓肠肌内侧头部分肌瓣缝合,重建伸膝装置。结果全部患者随访29~194个月,中位随访88个月。局部复发5例,浅表切口不愈合、坏死、积液8例,延迟深部感染11例,假体松动3例。假体5年存留率为84%,10年存留率为70%。术后1年MSTS评分平均24.2分,优良率67.1%。结论对于合并病理性骨折或Campanacci Ⅲ级的胫骨近端骨巨细胞瘤患者,采用整块切除旋转铰链型膝关节置换是有效的治疗方法,能较好地恢复膝关节功能,提高患者生活质量。

Objective To investigate the clinical outcomes of endoprosthetic replacement of giant cell tumors in the proximal tibia. Methods A total of 76 patients with giant cell tumors of bone in the proximal tibia, who had undergone endoprosthetic replacement treatment from June 2000 to February 2014, were enrolled in this study. There were 32 males and 44 females, with an average age of （ 38 ± 6.8 ） years. According to the radiology Campanacci’s classification, 36 cases were classified at primary level III and 13 cases at primary level II. In 27 recurrent patients, 22 cases were classified at level III and 5 cases at level II. According to the tumor range, all tumors underwent extensive resection. Rotating hinge type artificial knee prosthesis was used. The gastrocnemius muscle flap was rotated forward and upward to cover the surface of the tibial prosthesis, and the beginning point of the medial head of the gastrocnemius and the residual proximal patellar tendon were sutured to reconstruct the extensor mechanism. Results A total of 76 patients were followed up, with a median follow-up of 88 months. As for the complications, local recurrence developed in 5 patients, superficial wound unhealing in 8 patients, delayed deep infection in 11 patients, and aseptic loosening in 3 patients. The 5-year survival rate of the prosthesis was 84%, and the 10-year survival rate was 70%. The MSTS score was 24.2 in average. Conclusions For patients with pathological fracture or Campanacci grade III, it is an effective method to treat giant cell tumors in the proximal tibia with the en bloc resection of tumor and rotating hinge type artificial knee prosthesis replacement, which can help restore the knee joint function and improve the patients’ quality of life.