膝关节周围CampanacciⅢ级骨巨细胞瘤的手术治疗

Surgical treatment of Campanacci GradeⅢgiant cell tumor of bone around knee joint

目的比较刮除灭活内固定与瘤段切除重建两种术式治疗膝关节周围CampanacciⅢ级骨巨细胞瘤(GCTB)在术中出血量、术后功能评价、局部复发及术后并发症等方面的差异。方法回顾性分析我院2011年6月~2020年5月收治的42例膝关节周围CampanacciⅢ级GCTB患者的临床资料,比较两种术式的手术时间、术中出血量、术后住院天数、术后辅助行走时间、末次随访下肢功能MSTS及AKS评分和肿瘤复发情况。对比两种手术方式对CampanacciⅢ级GCTB患者肿瘤转归及下肢功能恢复情况的影响。结果患者均获得随访,平均随访时间46.7(7~110)个月。刮除灭活内固定术组住院天数、术后辅助行走时间低于瘤段切除重建术组,差异有统计学意义(P<0.05);刮除灭活内固定组术后MSTS评分、AKS功能评分高于瘤段切除重建术组,差异有统计学意义(P<0.05);瘤段切除重建术组肿瘤复发率明显低于刮除内固定术组,差异有统计学意义(P<0.05)。结论刮除灭活内固定、瘤段切除重建均是治疗膝关节周围CampanacciⅢ级GCTB的有效方法,前者可保留患者膝关节功能、术后可使患者早期下床活动;而后者术后复发率明显低于前者,可避免因截肢和关节融合对患者生活质量产生的影响。

Objective To compare the differences of intraoperative blood loss,postoperative functional evaluation,local recurrence and postoperative complications between curettage and inactivation with internal fixation and bone tumor resection with reconstruction in the treatment of giant cell tumor of bone(GCTB)around the knee joint.Methods The clinical data of 42 patients with Campanacci grade III GCTB around the knee joint treated in our hospital from June 2011 to May 2020 were retrospectively analyzed.The operation time,intraoperative blood loss,postoperative hospital stay,postoperative walking time,MSTS and AKS scores of lower limb function and tumor recurrence were compared between the two methods.Objective to compare and analyze the effect of two surgical methods on the tumor prognosis and lower limb function recovery of patients with Campanacci grade III GCTB.Results The patients were followed up for an average of 46.7(7-110)months.The postoperative hospitalization days and postoperative walking time of the curettage and inactivation internal fixation group were lower than those of the tumor resection and reconstruction group,and had statistical significance(P<0.05).The MSTS score and aks function score of the curettage inactivated internal fixation group were higher than those of the tumor segment resection and reconstruction group(P<0.05).The tumor recurrence rate in the tumor resection and reconstruction group was significantly lower than that in the curettage and internal fixation group(P<0.05).Conclusion Curettage and inactivation with internal fixation and bone tumor resection with reconstruction are effective methods for the treatment of Campanacci grade III GCTB around the knee joint.The former can preserve the knee joint function,postoperative hospital stay and early ambulation;the latter can significantly reduce the postoperative recurrence rate.