股骨近端骨巨细胞瘤的刮除治疗

目的了解股骨近端骨巨细胞瘤行刮除术后的预后情况及相关因素。方法1993年～2004年共收治股骨近端骨巨细胞瘤35例，其中施行刮除术且获随访12例。男7例，女5例，平均年龄21岁（19～40岁）。Campannacci分级：Ⅰ级3例、Ⅱ级4例（骨折2例）、Ⅲ级5例。11例术前行穿刺活检，8例阳性，3例阴性。前入路7例，外侧入路5例。刮除＋骨水泥填充3例，刮除＋植骨9例。术后病理Jaffe分级：I级7例、Ⅱ级5例。结果随访24～80个月（平均47个月）。有4例复发，复发率为33．3％，复发时间为术后3～38个月（平均19．3个月）。结论股骨近端骨巨细胞瘤行刮除术后复发率较高。术前确诊、X线分级Ⅰ级者复发率低，病理骨折复发率高。股骨颈解剖结构复杂，不易在直视下刮除和难以切除菲薄的包壳是复发的主要原因。

Curettage for treating giant cell tumor of proximal femur

Objective To investigate the prognosis of giant cell tumors of proximal femur with treatment of curettage. Methods 12 patients with giant cell tumors of proximal femur were treated with curettage and followed-up for more than 24 months. Patients age ranged from 19 to 40 years old and there were 7 male and 5 female. According to Campanacci grading system, 3 patients were stage I, 4 stage II, and 5 stage III. Two of the stage II patients had pathological fracture. 3 patients were packed with bone cement and other 9 patients were packed with bone grafts. Results 12 patients were followed up for the mean of 47 months (range, 24-80 months). Recurrence occurred in 4 patients at a mean of 19.3 months postoperatively (range, 3- 38 months). Conclusions Giant cell tumors of proximal femur treated by curettage had a high recurrence rate (33.3%). Grade I patients had lower recurrence rate. The higher recurrence was related to the occurrence of pathologic fracture. It was very difficult to remove all tumor tissue by because of the complex femoral anatomic structure and this could be the main reason of high recurrence rate of giant cell tumors of proximal femur.