局部应用唑来膦酸治疗膝关节周围骨巨细胞瘤的临床效果分析

Clinical effect of Zoledronic acid for local application in the treatment of giant cell tumor around the knee

目的对比分析手术部位局部辅助使用唑来膦酸和术后单纯静脉使用唑来膦酸治疗膝关节周围骨巨细胞瘤临床效果。方法 2010年2月至2015年10月在成都医学院第一附属医院就诊且病理活检确诊为骨巨细胞瘤的膝关节周围巨细胞瘤38例病人。按抓阄法随机分为观察组和对照组,每组19例。两组病人手术治疗方案均为病灶扩大切除+同种异体骨植骨,术后给予正规静脉唑来膦酸使用6个疗程以上(每3～4周使用一次,每次4 mg)。观察组在植骨区局部使用唑来膦酸,对照组未局部使用。结果平均随访43.1个月(23～64个月)。全部病人术后肢体功能恢复好,观察组1例伤口愈合不佳,对照组伤口全部一期愈合,两组病人伤口并发症发生率差异有统计学意义(χ~2=8.00,P=0.032)。两组病人术后疼痛减轻,与术前相比均差异有统计学意义(观察组t=74.58,P=0.002;对照组t=47.65,P=0.011),但术后3个月两组病人的疼痛视觉模拟(Visual Analogue Scale,VAS)评分差异无统计学意义(t=2.21,P=0.068)。两组病人术后6个月的骨愈合率均为100.0%。观察组病人复发率为5.2%,低于对照病人复发率10.5%,差异有统计学意义(χ~2=6.73,P=0.039)。结论手术局部使用唑来膦酸有利于降低复发率,可作为辅助治疗膝关节周围骨巨细胞瘤的临床治疗方案,但增加了伤口不愈合的风险。

Objective To compare and analyze the clinical effects of topical use of Zoledronic acid and the intravenous use of Zoledronic acid alone in the treatment of giant cell tumor around the knee.Methods Thirty-eight patients with giant cell tumors around the knee joints who were diagnosed as giant cell tumors of bone by pathological biopsy in the First Affiliated Hospital of Chengdu Medical College from February 2010 to October 2015 were collected.The patients were assigned into observation group and control group randomly by drawing lots,with 19 cases in each group.Patients of the two groups received extended lesion resection plus allograft and postoperative regular intravenous Zoledronic acid for more than 6 courses(once every 3 to 4 weeks with 4 mg).The Zoledronic acid was used locally in the bone graft area in observation group,and was not used locally in control group.Results The mean follow-up was 43.1 months(23 to 64 months).The recovery of limb function in all patients was good.One case in the observation group had poor wound healing,and the control group had all primary healing.The rate of wound complications in the two groups was statistically significant(χ^2=8.00,P=0.032).Postoperative pain in two groups of patients was relieved in comparison with preoperative statistics,there was a statistically significant difference(observation group:t=74.58,P=0.002;control group:t=47.65,P=0.011);3 months after surgery,the two groups of patients showed no significant difference in visual analogue scale(VAS)score(t=2.21,P=0.068).The bone healing rate of the two groups was 100%at 6 months after operation.The recurrence rate of the observation group was 5.2%,which was lower than 10.5%of the control group,and the difference was statistically significant(χ^2=6.73,P=0.039).Conclusion Topical use of Zoledronic acid is beneficial in reducing the recurrence rate and can be used as a clinical treatment for giant cell tumor of the knee joint,but it increases the risk of nonunion.