四肢骨巨细胞瘤囊内刮除术后复发因素分析及治疗体会

Analysis on Factors for Giant Cell Tumor Recurrence of Bone in Limbs After Intracapsular Curettage and Treatment Experience

目的:回顾性分析骨巨细胞瘤术后复发的危险因素。方法:选取2012年11月-2017年11月骨巨细胞瘤患者32例,其中术后复发4例,未复发28例。通过单因素分析比较,总结囊内刮除骨巨细胞瘤性别、年龄、发病部位、碱性磷酸酶、是否合并动脉瘤样骨囊肿,是否伴有病理性骨折、术中处理方式、Campanacci分期及p53、CD68、Ki67与术后复发的关系。采用多因素Logistic回归方程,确定影响肿瘤复发的相关危险因素。结果:经方差分析,p53(P=0.044)、发病部位(P双侧=0.088)与骨巨细胞瘤术后复发有关,而其他因素与术后复发无关。多因素Logistic回归分析显示,发病部位与肿瘤术后复发有关(P=0.044)。结论:术中对于小关节的处理需更加仔细,才能降低骨巨细胞瘤复发。

Objective: To retrospectively analyze the risk factors for giant cell tumor recurrence of bone after surgery. Methods:From November 2012 to November 2017, 32 patients with giant cell tumor of bone were selected, including 4 relapse cases and 28 non-relapse cases after surgery. Through univariate analysis and comparison, the relationship between gender, age, site of onset,alkaline phosphatase, presence or absence of combined aneurysmal bone cyst, presence or absence of concurrent pathological fracture, intraoperative management, Campanacci stage, p53, CD68, Ki67 of intracapsular curettage for giant cell tumor of bone and postoperative recurrence was summarized. Multivariate Logistic regression equation was used to determine the relevant risk factors affecting tumor recurrence. Results: Analysis of variance p53(P=0.044) and site of onset(bilateral P=0.088) were related to the recurrence of giant cell tumor of bone after surgery, while other factors were not related to the recurrence after surgery. Multivariate Logistic regression analysis showed that the site of onset was related to tumor recurrence after surgery(P=0.044). Conclusion:Intraoperative treatment of small joints needs to be more careful in order to reduce the recurrence of giant cell tumor of bone.