膝关节周围骨巨细胞瘤的临床治疗分析

The Clinical Analysis of Giant Cell Tumor of Bone Around the Knee

目的研究手术治疗膝关节周围骨巨细胞瘤的肢体功能、局部复发及术后并发症情况,并探讨不同类型膝关节周围骨巨细胞瘤的合理术式。方法回顾性分析2007年1月-2010年1月间入院诊治的96例膝关节周围骨巨细胞瘤患者的临床资料,治疗后均随访3年,评价患者的肢体功能和关节功能,总结患者的术式、术后复发情况、术后并发症。对术后复发危险因素及影响肢体功能的因素进行单因素分析。结果关节功能优良率囊内切除术组为76.79%,切刮除组为87.50%,边缘刮除组为81.25%,囊内切除术组显著低于后两组(P<0.05);肢体功能优良率囊内切除术组为76.78%,切刮除术组为75.00%,边缘切除术组为78.13%,3组差异不显著(P>0.05)。在随访3年内,共12例复发,复发率为12.50%。随访期间,未见神经血管损伤,囊内切除术与切刮除术未见术后并发症,边缘切除术出现7例假体并发症。影响肢体功能的因素有首诊原发/复发、Enneking分期、软组织肿块及术式(P<0.05);而术后复发危险因素只与术式有关(P<0.05)。结论囊内切除、切刮除、边缘刮除对膝关节周围骨巨细胞瘤的治疗各有利弊,且术式的选择对术后复发及肢体功能均有一定的影响;要求临床医师结合患者年龄、肿瘤分级分期等综合选择术式。

Objective To study limb function ,local recurrence and postoperative complications of surgery for giant cell tumor of bone around the knee ,and explore reasonable surgical procedures in different types of giant cell tumor of bone around the knee .Methods Clinical data of 96 cases of giant cell tumor of bone around the knee were retrospectively analyzed ,limb function and joint function,surgical treatment,postoperative recurrence,postoperative complications were followed up for 3 years.Factors affecting recurrence and risk factors of physical function were studied by univariate analysis .Results Excellent rates of joint function in intracapsular resection group ,cut curettage group and margin resection group were 76.79%,87.50% and 81.25%, intracapsular resection group was significantly lower than that of the other 2 groups (P<0.05);excellent rates of limb function in intracapsular resection group ,cut curettage group and margin resection group were 76.78%,75.00%and 78.13%,the 3 groups had no significant difference (P>0.05).In the follow-up of 3 years,there were 12 cases of recurrence,the recurrence rate was 12.50%.During follow-up,there had no neurovascular injury ,intracapsular resection group and cut curettage group had no com-plications ,margin resection group had 7 implant complications .Factors affecting limb function were first diagnosed with primary /recurrence,Enneking staging,and surgical soft tissue mass (P<0.05);while the only risk factor for recurrence was surgical re-lated (P<0.05).Conclusion Intracapsular resection,cut curettage and margin resection for giant cell tumor of bone around the knee has advantages and disadvantages ,and the choice of surgical recurrence and limb function has a certain role;age,tumor grading and staging and other comprehensive selection of surgical procedures need to be considered .