胫骨远端骨巨细胞瘤治疗的多中心回顾性研究

Therapeutic problems of giant cell tumor in the distal tibia： a multicenter retrospective study

目的探讨胫骨远端骨巨细胞瘤的发病特点、治疗方法，分析影响复发及肢体功能的相关危险因素。方法回顾性分析2000年10月至2014年6月国内3家骨肿瘤治疗中心（天津市天津医院、河北医科大学第三医院、郑州市骨科医院）15例胫骨远端骨巨细胞瘤患者的临床资料，男8例，女7例；年龄25-59岁，平均（35．9±10．4）岁。首次症状出现至入院诊治时间间隔为7天-28个月，平均9．2个月。Campanacci骨巨细胞瘤影像学分级Ⅱ级11例、Ⅲ级4例，其中Ⅱ级中2例合并病理性骨折。手术采用扩大切刮术11例，瘤段切除重建术4例，分析影响术式选择、复发及肢体功能的因素，包括肿瘤大小、是否波及踝关节面、Campanacci分级、是否合并病理性骨折。将患者是否发生病理性骨折以及Campanacci分级对手术方案的选择进行统计学分析；是否发生病理性骨折、Campanacci分级、手术方式与术后肌肉骨骼肿瘤协会（Musculoskeletal Tumor Society，MSTS）对术后复发率的影响进行统计分析。结果15例胫骨远端初治GCT患者均获得随访，术后随访时间25-108个月，平均（62．3±25．2）个月，GCT无转移，无患者死亡。4例行瘤段切除术的患者中1例复发，采取小腿中段截肢术，11例行扩大刮除术的患者中1例复发，再次扩大切刮并骨水泥填充钢板内固定术，患者术后功能恢复良好。单因素分析显示，是否发生病理性骨折不影响GCT手术治疗方案的选择（P=1．000），Campanacci分级影响GCT手术治疗方案的选择（P=0．001）；病理性骨折、Campanacci分级、手术方式与患者的局部复发率均无关（P〉0．05）；CampanacciⅡ级行扩大切刮术的患者术后MSTS评分为（26．82±1．83）分，CampanacciⅢ级瘤段切除术的患者术后MSTS评分为（23．50±1．00）分，行扩大切刮术患者术后肢体功能优于瘤段切除术（t=3．385，P=0．005），是否合并病理性骨折与患者术后MSTS评分差异无统计学意义。结论胫骨远端GCT的Campanacci分级以及是否合并病理性骨折影响术式的选择和术后功能恢复的情况。

Objective To retrospective analysis the onset characteristics and outcome of surgical management in pa- tients with giant cell tumor （GCT） of distal tibia, explore the operation indication and the risk factors for recurrence and limb function. Methods From October 2000 to June 2014, Fifteen patients with GCT in the distal tibia from domestic three bone tumor centers were involved in this study. They included 8 males and 7 females, with an average age of 35.9±10.4 years. There were 11 cases of Campanacci II and 4 cases of Campanacci III. Two cases of Campanacci II occurred pathologic fracture. Expanded curet-tage surgery was performed in 11 cases and tumor resection with revascularization was performed in 4 cases. Factors Influencing the choice of surgery, recurrence and limb function were analyzed. These included tumor size, ankle condition, Campanacci grade, pathological fracture. Results All patients were followed up with a mean duration of 62.3±25.2 months, ranging from 26 to 60 months. One of 11 patients treated with extended curettage underwent local recurrence. One of 4 patients treated with marginal excision underwent local recurrence. The effect of Campanaeci classification and pathological fracture on selection of operation scheme was analyzed. The effects of pathological fractures, Campanacci classification, surgical methods and postoperative functional score （MSTS score） on postoperative recurrence rate were analyzed. Single factor analysis showed that the pathological fractures did not affect the selection of GCT surgical treatment plan （P=1.000）. Campanacci classification affected the selection of GCT surgical treatment plan （P=0.001）. Pathological fractures, Campanacci classification and surgical methods were not related to the local recurrence rate （P 〉 0.05）. Expanded curettage of Campanacci grade II patients with better postoperative MSTS score than tumor segment resected Campanacci grade ]II patients （t=3.385, P=0.005）. There was no significant relationship between pathological fracture and postoperative MSTS score. Conclusion Distal tibia GCT Campanacci classification and whether combined with pathological fracture or not affects the choice of surgical procedure and postoperative functional recovery.