软骨下骨植骨联合骨水泥填充治疗膝周骨巨细胞瘤的疗效评价

Evaluation of Subchondral Bone Grafting Combined with Bone Cement Reconstruction as Treatment of Giant Cell Tumor Around the Knee

目的:探讨采用病灶扩大刮除联合软骨下骨植骨、骨水泥填充治疗膝关节骨巨细胞瘤的临床应用可行性及疗效分析。方法:回顾分析2013年1月-2016年6月武汉大学中南医院骨肿瘤中心收治的具有完整临床病理及随访资料的19例初次诊治的邻膝关节骨巨细胞瘤。其中男11例,女8例,平均年龄(34.1±14.5)岁,其中Campanacci分级,Ⅰ级3例,Ⅱ级12例,Ⅲ级4例,Enneking分期:1期2例,2期12例,3期5例;患者术前均有不同程度疼痛症状。病变累及:股骨远端12例,胫骨近端7例。所有患者术前均经仔细评估确定肿瘤腔的完整性,术中仔细刮除肿瘤组织,应用高速磨钻处理瘤腔壁,联合软骨下骨区域植骨、骨水泥填充修复瘤腔,其中14例同时给予钢板内固定。结果:患者均获随访,平均随访(26.7±6.2)个月,1例复发并出现了出现了肺转移(5.3%),其余患者无局部复发及转移发生。参照术后Enneking肢体功能评分标准,本组患者平均得(26.1±2.1)分。复查X线片示所有患者内固定均牢靠,无软骨下骨骨折及关节退变的发生。结论:对于膝关节周围骨巨细胞瘤可以选择病灶扩大刮除联合软骨下骨植骨、骨水泥充填的手术方式进行治疗,该方法具有可早期负重、肢体功能恢复理想、近期复发率低、手术创伤较小等优点。

Objective:To evaluate the clinical effects of subchondral bone grafting combined with packing of the cavity with bone cement in the treatment of giant cell tumors around the knee.Methods:A retrospective analysis was performed in 19 patients of giant cell tumor close to the knee with complete clinicopathologic and follow-up data from January 2013 to June 2016.There were 11 males and 8 females with mean age of(34.1±14.5)years.According to Campanacci grade stage,there were 3 patients at gradeⅠ,12 at gradeⅡ,and 4 at gradeⅢ.While according to Enneking stage,there were 2 patients at stageⅠ,12 patients at stage,and 5 at stageⅢ.All patients had varying degrees of preoperative pain symptoms.In these patients,12 of distal femur and 7 of proximal tibia were involved.All patients were treated with aggressive curettage with subchondral bone grafting by high-speed burring and bone cement.Results:All patients were fol-lowed up.The mean follow-up period was(26.7±6.2)months.Except one patient of relapsed(5.3% )and developing pulmonary metastasis,there were no local recurrence or metastasis in the remainings.The postoperative functional evaluation was made according to Enneking standard with a mean score of 26.1±2.1.In addition,all patients had solid fixation without fracture of the subchondral bone and secondary osteoarthritis on plain radiographs.Conclusion:Patients with GCTB around the knee joint can be treated satisfactorily with subchondral bone grafting combined with bone cement,which are safe and effective.However,for the limited quantity of the original studies,a long-term effect and further observation are needed.