微波消融联合手术治疗下肢骨巨细胞瘤的效果及对关节功能的影响

Effect of microwave ablation combined with surgery on giant cell tumor of bone in lower extremity and its effect on joint function

目的探讨微波消融联合手术治疗下肢膝关节周围骨巨细胞瘤的效果及对关节功能的影响。方法将100例骨巨细胞瘤患者采用随机数字表法分为研究组和对照组各50例,两组患者均采用瘤体刮除术+软骨下植骨+骨水泥重建+钢板内固定治疗,研究组同时采用微波消融手术对残留骨巨细胞瘤进行消融处理,对照组采用95%无水酒精处理。比较两组患者术后不同时间的骨骼肌肉系统肿瘤协会(MSTS)评分、局部复发率、手术并发症发生情况。结果在术后3个月、术后6个月分别观察,研究组和对照组的疼痛、整体功能、心理承受程度、支持物、行走功能、步态6个维度评分比较,差异均无统计学意义(P> 0.05);术后6个月,两组患者的疼痛、整体功能、心理承受程度、支持物、行走功能、步态6个维度评分均较术后3个月提高,差异均有统计学意义(P<0.05)。研究组患者手术并发症总发生率为4%(2/50),与对照组的8%(4/50)比较,差异无统计学意义(P>0.05)。术后36~68个月,研究组术后复发率为0,低于对照组的10%(5/50),差异有统计学意义(P<0.05)。结论微波消融联合手术治疗下肢膝关节周围骨巨细胞瘤可有效降低患者术后复发的风险。

Objective To explore the effect of microwave ablation combined with surgery on giant cell tumor(GCT)of bone around knee joint of lower extremity and its effect on joint function.Method A total of 100 patients with GCT of bone were included in the research and randomized into study group or control group following a random number table,with 50 cased in each.Both groups of patients were treated with tumor curettage+subchondral bone implantation+bone cement reconstruction+internal fixation of steel plate,meanwhile the study group also adopted microwave ablation surgery to ablate residual GCT of bone,while the control group was treated with 95% anhydrous alcohol.The two groups were compared for Association for Tumors of the Skeletal and Muscular System(MSTS) score at different time points post-surgery,local recurrence rate,and post-operative incidence of surgical complications.Result At 3 months and 6 months after the operation,there were no statistically significant difference in the scores of the following six aspects:pain,overall function,psychological endurance,support,walking function,and gait(P>0.05);At 6 months after operation,the scores of the above six aspects of the two groups were significantly improved compared with those at 3 months after operation(P<0.05).The overall incidence of postoperative complications was 4%(2/50) in study group,compared to 8%(4/50) in control group,with no statistically significant differences noted(P>0.05).At 36-68 months post-surgery,the postoperative recurrence rate of the study group was 0,and it was evidently lower than that of the control group at10%(5/50)(P<0.05).Conclusion Microwave ablation combined with surgery effectively reduces the risk of postoperative recurrence among patients with GCT of bone around the knee of the lower extremity.