扩大病灶刮除及骨水泥填塞植骨内固定术治疗骨巨细胞瘤22例分析

Analysis of 22 Cases of Giant Cell Tumor of Bone Treated by Enlarged Curettage and Bone Cement Filling and Bone Grafting and Internal Fixation

目的:因骨巨细胞瘤(Giant cell tumor of bone)极为少见,本次主要是通过分析本院22例下肢骨巨细胞瘤来评价扩大病灶刮除及骨水泥填塞植骨内固定术治疗骨巨细胞瘤的疗效,并讨论骨巨细胞瘤的最新治疗进展。方法:选择延安大学附属医院骨科病区2015年1月~2020年1月收治22例下肢骨巨细胞瘤患者,其中男5例,女17例,其中股骨远端骨巨细胞瘤13例,胫骨近端骨巨细胞瘤9例,所有患者及家属均同意手术,并签署手术知情同意书,行扩大病灶刮除及骨水泥填塞植骨内固定术,观察患者手术时间、术中出血量、术前与术后1个月视觉模拟(Visual analogue scale, VAS)评分及国际骨与软组织肿瘤协会(Musculoskeletal Tumor Society, MSTS)评分。结果:22例患者手术时间(93.55 ±14.82) min、术中出血量(257.72 ±73.73) ml、术前与术后1个月VAS评分(6.95 ±1.05)分与(1.91 ±0.75)分,术前与术后1个月MSTS评分分别为(10.32 ±2.82)分与(26.32 ±1.55)分,所有患者随访6~60个月,其中22例患者中,有2例患者与术后1~2年内复发,复发率约为9.1%,其余患者观察期间并未复发。结论:骨巨细胞瘤患者的预后和复发与手术的方式有着密切的关系,虽扩大病灶刮除及骨水泥填塞植骨内固定术不如瘤段切除更加彻底,但综合考虑患者自身因素,该手术方式不仅可以极大降低复发率,而且可以最大程度的保留患者的肢体功能。

Objective: Because Giant cell tumor of bone is extremely rare, this time, 22 cases of lower limb giant cell tumor in our hospital were analyzed to evaluate the curative effect of enlarged focus curettage and bone cement filling and bone grafting internal fixation in the treatment of giant cell tumor of bone, and to discuss the latest treatment progress of giant cell tumor of bone. Methods: From January 2015 to January 2020, 22 patients with giant cell tumor of lower limbs were admitted to the Department of Orthopaedics, Affiliated Hospital of Yan’an University, including 5 males and 17 females, including 13 cases of giant cell tumor of distal femur and 9 cases of giant cell tumor of proximal tibia. All patients and their families agreed to the operation, signed the informed consent form of the operation, and performed enlarged lesion scraping and bone cement filling and bone grafting internal fixation. Operation time, intraoperative blood loss, Visual analogue scale (VAS) scoring standard before and one month after operation, and MSTS scoring standard were observed. Results: The operation time of 22 patients was (93.55 ±14.82) min, the blood loss during operation was (257.72 ±73.73) ml, VAS scores (6.95 ±1.05) and (1.91 ±0.75) before and 1 month after operation, MSTS scores (10.32 ±2.82) and (26.32 ±1.55) before and 1 month after operation, respectively. All patients were followed up for 6 to 60 months. Among 22 patients, 2 patients relapsed within 1 to 2 years after operation, with a recurrence rate of about 9.1%, while the rest patients did not relapse during observation. Conclusion: Prognosis and recurrence of giant cell tumor of bone are closely related to surgical methods. Although curettage of enlarged lesion and bone cement filling and bone grafting and internal fixation are not as thorough as resection of tumor segment, but the operation method can not only greatly reduce the recurrence rate but also preserve the limb function of patients to the greatest extent considering the patient’s own factors.