| 29例复发性动脉瘤样骨囊肿的临床诊治经验 |
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| 引用本文： | 唐海军,刘云,肖增明,赖银娟,刘建宏,韦昌武.29例复发性动脉瘤样骨囊肿的临床诊治经验[J].中国肿瘤临床,2018,45(24):1254-1257. |
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| 作者姓名： | 唐海军 刘云 肖增明 赖银娟 刘建宏 韦昌武 |
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| 作者单位： | ①.广西医科大学第一附属医院脊柱骨病外科（南宁市530021） |
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| 基金项目： | 广西自然科学基金青年项目2017GXNSFBA198098广西高校中青年教师基础能力提升项目KY2016YB097 |
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| 摘 要： | 目的 探讨四肢复发性动脉瘤样骨囊肿（recurrent aneurysmal bone cyst，RABC）的临床、影像学特点，分析不同术式的疗效及预后，为其诊断和治疗提供经验。 方法 2008年1月至2016年1月就诊于广西医科大学第一附属医院经病理确诊的29例四肢RABC患者，其中男性15例，女性14例；复发平均年龄为17.4（4~42）岁；胫骨近端12例，股骨远端11例，肱骨近端3例，股骨近端3例。复发时间为术后2~36个月，其中多数患者于术后2年内复发（22/29）。再行手术方式与例数:再次病灶刮除术24例（植骨充填18例，骨水泥6例），瘤段切除重建术5例（肿瘤假体重建4例；自体骨重建1例）。采用MTSS评分评估患肢术后功能，根据Mankin标准评定综合临床疗效。 结果 随访时间24~90个月，平均时间64个月。1例再次复发，总再复发率为3.4%。术后MTSS评分再次病灶内刮除术组为26~30分（平均29.1），瘤段切除术组为21~27分（平均23.0）；综合临床疗效再次刮除术组优良率为95.8%，切除术组为60%。 结论 ABC术后定期随访对于早期诊断病灶复发至关重要；再次刮除术术后复发率在可接受范围内，且术后患肢功能恢复良好，是四肢复发性ABC的首选治疗；对于关节面破坏严重、反复复发的患者，可选择瘤段切除+肿瘤假体重建治疗，但存在一定的远期并发症。
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| 关 键 词： | 动脉瘤样骨囊肿 复发 治疗 |
| 收稿时间： | 2018-10-05 |
Clinical diagnosis and treatment strategy for recurrent aneurysmal bone cysts of the extremities: a report of 29 cases |
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| Affiliation: | ①.Department of Spine and Orthopedics Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China②.Guangxi Medical University, Nanning 530022, China |
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| Abstract: | Objective To explore the clinical characteristics, imaging feature, surgical outcomes, and prognosis of recurrent aneurysmal bone cysts (RABC) of the extremities. Methods Between January 2008 and January 2016, 29 patients histopathologically diagnosed with RABC were treated at our hospital. These patients included 15 males and 14 females. The mean age at the time of diagnosis was 17.4 years(range 4-42 years). The most common site of the RABC was the proximal tibia (12 cases), followed by the distal femur (11 cases), and 3 cases each with involvement of the proximal humerus and the proximal femur. Recurrence was most commonly observed within 24 months following the initial treatment. Intralesional re-curettage was performed in 24 patients and en bloc resection of the tumor and reconstruction in 5 patients. The medial tibial stress syndrome (MTSS) score was used to evaluate postoperative function of the affected limb, and the comprehensive clinical efficacy was evaluated on the basis of the Mankin criteria. Results The mean follow-up duration was 64 months (range 24-90 months). Re-recurrence occurred in 1 patient with a total re-recurrence rate of 3.4%. The postoperative MTSS score was 26-30 points (mean 29.1 points) in the intralesional re-curettage group and 21-27 points (mean 23.0 points) in the tumor resection group. Based on the Mankin criteria, excellent and good clinical outcomes were observed in 95.8% of patients in the intralesional and 60% of the patients in the tumor resection and reconstruction groups. Conclusions Regular followup is essential for the early diagnosis of RABC. The re-recurrence rate following intralesional re-curettage was within an acceptable range, and postoperative limb function was satisfactory; therefore, intralesional re-curettage is the treatment of choice for RABC involving the extremities. Tumor resection can be performed in patients with severe articular surface destruction and repeated recurrence, although long-term complications may occur. |
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