胫骨近端后侧软骨母细胞瘤的外科治疗

Surgical treatment of posterior proximal tibia chondroblastoma

目的探讨好发于胫骨后侧不同部位的软骨母细胞瘤最佳的手术入路。方法 2006年4月至2016年4月,回顾分析我科收治20例胫骨近端骨骺后侧发病的软骨母细胞瘤,资料不全的患者排除。20例均行关节外病灶扩大刮除术。分析患者临床、影像学及病理资料,并对患者进行随访,得出不同的发病部位最佳的手术入路。结果我科共收治胫骨近端骨骺的软骨母细胞瘤70例,其中发病于后侧资料齐全者20例。患者发病年龄为12~31岁,中位发病年龄为15岁。后内侧及后正中发病者12例,均行BANKS入路。后外侧发病者8例,行膝关节后外侧入路。术后均获随访,随访时间6~60个月,平均18个月。随访期间,1例复发,给予再次扩大刮除术。20例中,4例就诊时骺板已闭合,其余16例骺板未闭患者中,有12例骺板被病变侵及。但是随访过程中均未发现肢体发育畸形。结论 BANKS入路能良好的显露胫骨近端后正中,尤其是后内侧的病灶;膝关节后外侧入路能良好的显露胫骨近端后外侧的病灶。关节外扩大刮除术治疗胫骨近端后侧的软骨母细胞瘤可以获得满意的临床效果。

Objective To explore the optimal surgical approach in the treatment of posterior proximal tibia chondroblastoma. Methods From April 2006 to April 2016, clinical data of 20 patients were reviewed. Extended curettage was applied in all 20 cases. The most appropriate surgical approach for different sites was concluded by surgical, imaging, pathological, and follow-up record analysis. Results The age of the patients ranged from 12 to 31 years, with a median age of 15 years. Banks approach was performed in 12 cases of the posterior medial and posterior median. Posterolateral approach was performed in 8 cases of posterolateral onset. The average follow-up was 18 months（ range： 6-60 months）. Recurrence was observed in 1 case, and the second extended curettage was applied. Epiphyseal plate was closed from the onset in 4 cases. In remaining 16 cases, the epiphyseal plate was invaded in 12 cases. However, no limb malformation was found during the follow-up. Conclusions Banks approach can well reveal the central, especially posterior medial focus of the proximal tibia. The posterolateral approach of the knee joint can reveal the posterolateral focus of the proximal tibia. Extended curettage can obtain satisfactory clinical results in the treatment of posterior proximal tibia chondroblastoma.