保膝与假体置换治疗膝关节周围骨巨细胞瘤比较

Knee preservation versus prosthetic replacement for giant cell tumor of bone around knee

[目的]探讨瘤体刮除骨水泥填充保膝手术与瘤段切除肿瘤型假体置换治疗膝关节周围骨巨细胞瘤的临床疗效。[方法]回顾性分析2010年2月~2018年3月本科手术治疗的30例膝关节周围骨巨细胞瘤患者。其中,17例采用瘤体刮除骨水泥填充治疗(保膝组),13例接受瘤段切除人工膝假体置换(置换组)。比较两组临床资料,并探讨肿瘤复发的因素。[结果]两组患者均顺利手术,保膝组在手术时间、术中出血量、住院费用方面显著优于置换组(P<0.05);保膝组切口并发症显著少于置换组(P<0.05)。随访(27.82±2.17)个月。术前两组间MSTS评分和HSS评分的差异无统计学意义(P>0.05),末次随访时,保膝组的MSTS评分及HSS评分显著高于置换组(P<0.05)。末次随访时复发患者保膝组3例,置换组2例,差异无统计学意义(P<0.05)。复发组与未复发组患者年龄分布差异无统计学意义(P>0.05),复发组Campanacci分级Ⅲ级率显著高于未复发组(P<0.05),复发组肿瘤体积显著大于未复发组(P<0.05)。[结论]瘤体刮除骨水泥填充治疗膝关节周围骨巨细胞瘤临床效果优于肿瘤型假体置换,肿瘤复发与其病理分级及体积相关。

[Objective]To compare the clinical outcomes of knee preservation by curettage and cement filling versus prosthetic replacement secondary to tumor-segment resection for giant cell tumor of bone(GCT)around the knee.[Methods]A retrospective study was conducted on 30 patients who underwent surgical treatment for GCT around the knee in our hospital from February 2010 to March 2018.Of them,17 patients received curettage and bone cement filling for knee preservation(the KP group),while the remaining 13 patients underwent prosthetic replacement secondary to tumor-segment resection(the PR group).The two groups were compared regarding clinical documents,and the factors related to tumor recurrence were searched.[Results]All patients in both groups had operation finished smoothly.The KP group proved significantly superior to the PR group in operation time,intraoperative blood loss and hospital expense(P<0.05).In addition,the KP group had significantly less complications related to incision than the PR group(P<0.05).The follow-up period lasted for(27.82±2.17)months on average.Although no statistical differences in the aforesaid 2 parameters were noticed between the two groups before operation(P>0.05),the KP group was significantly superior to the PR group in MSTS and HSS scores at the latest follow up(P<0.05).Regarding to tumor recurrence,the incidence was of 3 cases in the KP group,whereas 2 cases in the PR group,which was not statistically significant(P>0.05).The recurrent patients had significantly higher ratio of Campanacci gradeⅢ,and the tumor volume were bigger than the non-recurrence patients(P<0.05).[Conclusion]The knee preservation by curettage and cement filling is superior to prosthetic replacement secondary to tumor-segment resection for GCT in term of clinical outcomes in this study.The recurrence of GCT might be related to the pathological grade and tumor volume.