膝关节周围骨巨细胞瘤的外科治疗

目的 比较不同手术方法治疗膝关节周围骨巨细胞瘤的疗效.方法 2000年5月-2008年5月收治骨巨细胞瘤37例,男22例,女15例,年龄19～56岁,平均32岁.股骨远端19例,胫骨近端18例.Campanacci分级：Ⅰ级4例,Ⅱ级23例,Ⅲ级10例.根据肿瘤部位、Campanacci分级及患者年龄,采取不同的手术方法.其中,单纯刮除植骨或骨水泥填充10例,刮除植骨内固定16例,瘤段切除＋人工关节置换11例.结果 随访时间1-9年,平均5年,刮除植骨组有3例复发,复发率为11.5%,瘤段切除＋关节置换组无复发,术后患者Enneking功能评定：优19例,良8例,可5例,差5例,总满意率为86.5%.结论 病灶刮除植骨是骨巨细胞瘤基本的外科治疗方法,局部辅助处理措施可降低病灶刮除术后的复发率.瘤段切除适用于Campanacci Ⅲ级骨巨细胞瘤,虽复发率较低,但重建后的并发症相对较多.

Surgical treatment of giant cell tumor around the knee joint

Objective To compare the efficacy of different surgeries in the treatment of giant cell tumors around the knee joint. Methods 37 patients （22 male and 15 female） who were admitted between May 2000 and May 2008 were involved. They were aged from 19 to 56, with the average age being 32. All patients sustained giant cell tumor around the knee joint. The tumors were at the distal femur （n=19） and proximal tibia （n=18）. According to the Campanacci＇s staging system, the classification were stage I （n=4）, stage II （n=23）, and stage III （n=10）. On the basis of tumor site, Campanacci＇s staging system and the patient＇s age, 10 patients underwent tumor curettage with bone graft or cementation; 16 underwent curettage with bone graft and internal fixation; and 11 underwent en block excision of the tumor and replacement with joint prostheses. Results All patients were followed up for 1 to 9 years, with 5 years on average. 3 of the patients who underwent curettage had relapsed. The relapse rate was 11.5% （3/26）. Patients who underwent en block excision of the tumor and eplacement with joint prostheses did not have relapse. According to Enneking evaluation system, the results were excellent （n=19）, good （n=8）, fair （n=5）, and poor （n=5）. The overall satisfaction rate was 86.5% （32/37）. Conclusions Curettage with bone graft is a basic surgical treatment for giant cell tumor of the bone. Local adjunctive treatment can reduce recurrence rate. En block excision is indicated by tumor of stage Ⅲ. The recurrence rate is low after this procedure, but relatively more complications might occur after reconstruction.