扩大刮除并骨水泥填充治疗骨巨细胞瘤的临床诊疗分析

Clinical Diagnosis and Treatment of Giant Cell Tumor of Bone Treated by Expanded Curettage and Bone Cement Filling

目的探讨骨巨细胞瘤行扩大刮除并骨水泥填充治疗的临床效果,以期进一步指导临床诊疗。方法回顾性分析2010年9月至2016年4月在我院行扩大刮除并骨水泥填充术式治疗的骨巨细胞瘤(giant cell tumor ofbone,GCT)患者64例,男性28例,女性36例;年龄16～59岁,平均31.6岁。肿瘤部位:股骨远端26例,胫骨近端17例,股骨近端8例,肱骨近端10例,距骨2例,跟骨1例。肿瘤影像学分级按Campanacci分级标准,其中Ⅰ级患者20例,Ⅱ级患者29例,Ⅲ级患者15例。将患者的性别、年龄、肿瘤生长部位、Campanacci分级、骨与软组织肿瘤协会(musculoskeletal tumor society,MSTS)评分、有无病理性骨折、有无软组织肿块、肿瘤大小(长径)与肿瘤复发进行单因素分析;多因素分析采用Logistic回归分析;不同影像学分级与肿瘤复发相关性采用χ2检验。结果 64例患者均获得随访,随访时间12～74个月,平均42.8个月。64例患者中肿瘤复发8例,复发率为12.5%,术后无远处转移及恶变者。术后肢体功能评价数值为(27.06±1.45)分;多因素Logistic回归分析,结果显示只有Campanacci分级是影响复发的关键因素(回归系数2.368,P=0.04)。经χ2检验分析,CampanacciⅠ级与Ⅱ级、Ⅰ级与Ⅲ级术后复发率P值分别为0.007、0.002,差异有统计学意义(P<0.05),CampanacciⅡ级与Ⅲ级的P值为0.23,差异无统计学意义(P>0.05)。本组病例术后长期随访均未出现关节面塌陷、骨折等相关并发症,关节活动度良好,行走功能均较为满意。结论扩大刮除并骨水泥填充是治疗GCT的一种可靠治疗方式,术后整体复发率相对较低,肢体功能恢复较为满意;Campanacci分级是影响其复发的关键因素。

Objective To explore the clinical effect of expand curettage and bone cement filling in (giant cell tumor of bone,GCT)treatment,in order to further guide clinical diagnosis and treatment. Methods We retrospective analyzed 64 cases of GCT patients treated by expanded curettage and bone cement filling in our hospital,including 28 males and 36 females with a mean age of 31.6 years (range,16~59 y).Tumors were located in distal femur in 26 cases,proximal tibia in 17 cases,proximal femur in 8 cases,proximal humerus in 10 cases,talus in 2 cases and calcaneus in 1 case.Tumor image was graded according to the Campanacci classification criteria.There were 20 patients with grade Ⅰ,29 patients with grade Ⅱ,and 15 patients with grade Ⅲ.Eight clinical factors were analyzed by single factor analysis,such as gender,age,location of tumor,Campanacci classification,MSTS score,whether having a pathological fracture,Whether having a soft tissue mass,tumor size and tumor recurrence.Logistic regression analysis was used in multi-factor analysis,and the correlation between Campanacci grades and tumor recurrence was analyzed by χ^2 analysis. Results All 64 patients were followed up for 12 to 74 months,with an average of 42.8 months.Eight of 64 cases recurred with recurrence rate was12.5%.There was no distant metastasis and malignant transformation after operation.The postoperative evaluation of limb function was (27.06±1.45).The results of multivariate logistic regression model indicated that Campanacci grades was a key factor affecting tumor recurrence (regression coefficien t =2.368, P=0.04).The P values of recurrence rates were 0.007 and 0.002 for Campanacci grade Ⅰ and grade Ⅱ,as well as grade Ⅰ and grade Ⅲ,respectively after the analysis of χ^2 test,suggesting a statistical significance in their difference (P<0.05).The P value of Campanacci Ⅱ and Ⅲ was 0.23,which did not show any statistical significance (P >0.05).There were no complications such as articular surface collapse and fracture in the long-term follow-up group after operation.Instead,the joint mobility was good and walking function was satisfactory. Conclusion Expanded curettage and bone cement filling treatment is a reliable treatment for GCT,The overall recurrence rate is relatively low and the recovery of limb function is satisfactory.The Campanacci grades is the key factor that affects the recurrence.