股骨远端骨巨细胞瘤的外科分型与术式探讨

目的：探讨股骨远端骨巨细胞瘤的外科分型和术式。方法：回顾性分析1999年1月-2010年1月间我院收治的股骨远端骨巨细胞瘤患者62例的临床资料,其中男33例,女29例。平均年龄29.4岁。根据解剖部位及肿瘤病理学特点概括分为Ⅰ-Ⅴ型。Ⅰ型主要采用囊内刮除、50%氯化锌及磨钻处理、植骨复合内固定术;Ⅱ型主要采用边缘切除、结构性植骨复合内固定术;Ⅲ型主要采用瘤段切除、大段异体骨复合人工半关节置换术;Ⅳ型主要采用定制人工全膝关节置换术;Ⅴ型主要采用股骨中上段离断术,必要时结合放疗进行综合治疗。对相应分型给予的不同术式治疗和预后进行总结。结果：随访9-110个月（平均53.6个月）。术后复发8例,恶变2例,肺转移1例。参照Mankin等评定标准进行手术效果综合评价优良率（不包括Ⅴ型）：Ⅰ型81.5%;Ⅱ型50%;Ⅲ型75%;Ⅳ型79.2%;总优良率为78.7%。综合文献报道,术式对于相应分型的股骨远端骨巨细胞瘤效果良好。结论：股骨远端是骨巨细胞瘤的好发部位,根据解剖部位及肿瘤性质予以外科分型是科学合理的。这种分类方法和相应术式在控制肿瘤复发和指导后续治疗方面具备一定的优势。

The investigation of surgical typing and methods of bone giant cell tumor of distal femur

Objective：To discuss the surgical typing and surgical methods of bone giant cell tumor of distal femur with retrospective analysis and literature review.Methods：Sixty-two cases of bone giant cell tumor of distal femur from the 1999 to 2010 were collected,including 33 male and 29 female.The average age was 29.4 years old.They were divided into five types（I-V） and subtype with different anatomic site and oncopathological characteristic.Cases of Type I mainly performed curettement in cysts,50% zinc chloride and rubbing,and bone graft or bone cement filling.Cases of Type II mainly used marginal excision,and bimetal plate internal fixation of structured bone graft.Tumor section resection,and big segment variant combined with joint replacement were mainly used in Type III.Ordered total knee replacement was mainly used in Type IV.Chop amputation of the middle and superior segment of the femur were mainly used in Type V,which were combined with comprehensive treatment such as radiotherapy and chemotherapy when necessary.They were summarized different surgical treatment and prognosis according to different types.Results： Patients were followed-up for 9 months to 110 months.The average follow-up time was 53.6 months.One case had recurrence after surgery.Two cases became malignant.And one case had pulmonary metastasis.These cases were evaluated fineness rate of type I-IV with Mankin Method,and found the fineness rate of type I 81.5%,that of type II 50%,that of type III 75%,that of type IV 79.2%,and the total fineness rate 78.7%.The surgical methods were efficient according to corresponsive surgical types of bone giant cell tumor of distal femur.Conclusion： Distal femur is the predilection site of bone giant cell tumor.It is reasonable to type with the anatomic site and neoplasm property.The type is higher,the treatment is more difficult,and the prognosis is much worse.The types and corresponsive surgical methods have some superiority in hinting prognosis and guiding treatment.