股骨近端良性骨肿瘤和瘤样病变的手术治疗

股骨近端的良性骨肿瘤和瘤样病变并不少见，其病变亦多种多样，术前术后均易发生各种并发症。本文统计分析了我所１９８３年７月～１９９３年１０月收治的４９例股骨近端良性骨肿瘤和瘤样病变的病人，所有病人均经手术治疗，术后病理诊断。本组病人采用病变刮除，５０％氯化锌烧灼，皮质骨和／或松质骨植骨的方法治疗。不同的植骨方法对病变的预后有不同的影响，皮质骨植骨有助于防止术后髋内翻和病理骨折的发生。对于病变累及股骨头的病人，其病变较大可能发生股骨头无菌坏死，用单纯病变刮除，５０％氯化锌烧灼加植骨的方法难以奏效，需用更彻底的方法去除病变和功能重建，如人工股骨头置换。     

儿童长骨骨巨细胞瘤诊断及外科治疗

[目的]研究儿童四肢长骨骨巨细胞瘤的发病，评价不同手术方式的效果。[方法]对1994年12月～2003年12月本院收治的骨巨细胞瘤患者进行统计分析，根据Enneking分级系统分级，Ⅰ-Ⅱ级采用肿瘤刮除，氯化锌烧灼残腔，双氧水浸泡和异体植骨的方法进行治疗，Ⅲ级采用瘤段切除大段异体骨移植重建，术后定期随访。[结果]在128例骨巨细胞瘤患者中，儿童患者8例发病率为6．3％。其中Ⅰ级2例，Ⅱ级5例，Ⅲ级1例，伴发病理性骨折2例。6例行肿瘤刮除植骨后骨修复完善，肢体无畸形，2例病理性骨折愈合良好；1例异体骨段移植骨愈合良好，无塌陷及骨折，但患肢短缩2．5cm，无移植排斥；1例腓骨上端病变行腓骨小头切除，无功能障碍。术后随访2—9a，平均5．4a，未见肿瘤局部复发和远处肺转移。[结论]骨巨细胞瘤可以发生在儿童四肢长骨，刮除、氯化锌烧灼、双氧水浸泡和异体植骨可以达到满意效果，而瘤段切除会对儿童肢体发育产生影响。     

手术治疗18例儿童干骺端骨囊肿

目的探讨病灶刮除、同种异体骨植骨、锁定钛板内固定术治疗儿童干骺端骨囊肿的临床疗效。方法对18例干骺端骨囊肿患儿均采用病灶刮除、无水乙醇囊肿壁组织灭活、同种异体骨植骨、锁定板内固定治疗。结果 18例患儿均获得随访,时间11～34个月。患儿均无患肢疼痛及功能障碍,无复发。结论切开病灶刮除、同种异体骨植骨、锁定钛板内固定治疗儿童干骺端骨囊肿疗效较好。     

骨巨细胞瘤的治疗及复发病例分析

目的分析骨巨细胞瘤（giant cell tumor of bone，GCT）患者的临床特点、治疗方法及复发相关因素，探讨GCT治疗方法的选择。方法分析1993年1月～2005年1月收治的获随访的GCT患者38例，男13例，女25例。年龄14～59岁，平均31．1岁。经术前穿刺活检及术后证实为GCT，总结其临床特点并进行同顾性分析。所有患者均经病理诊断证实，Campanicci’s放射学分级：I级5例，Ⅱ级22例，Ⅲ级11例。按Enneking分期：I期9例，Ⅱ期21例，Ⅲ期8例。Jaffe’s病理分级：I级7例，Ⅱ级24例，Ⅲ级7例。29例GCT位于膝关节周围（股骨远端13例，胫骨近端16例），股骨近端、尺骨近端、桡骨远端、骶尾部各2例，腰椎1例。3种基本手术方法分别为：单纯刮除植骨4例；刮除植骨＋磨钻、石碳酸、50％ZnCl2、3％碘酒、骨水泥等辅助治疗26例；瘤段截除8例。结果38例术后获随访12～144个月，平均67个月。4例行单纯刮除植骨均复发；8例行瘤段切除，术后无复发；26例刮除植骨＋辅助灭活方法，8例复发。按Campanicci’s放射学分级：I级5例无复发，Ⅱ级22例复发6例，Ⅲ级11例复发6例。按Enneking分期：I期9例复发2例，Ⅱ期21例复发6例，Ⅲ期8例复发4例。术后共复发12例，复发率31．6％，均位于膝关节周围，复发时间为2～36个月，平均14．3个月。复发12例患者均行二次手术治疗，其中8例选择瘤段切除，4例行刮除植骨＋辅助灭活方法，术后均无复发。结论GCT术后复发多发生于膝关节周围，以胫骨侧为主，Campanicci’s放射学分级的Ⅱ级和Ⅲ级，且临床表现侵蚀性较高者。单纯刮除植骨复发率较高，正确使用辅助方法结合现代广泛刮除技术及现代的诊疗技术是降低复发率的重要手段。     

股骨头颈部肿瘤及瘤样病变的手术治疗

目的探讨股骨头颈部肿瘤及瘤样病变的手术治疗效果.方法对19例股骨头颈部瘤样病变及良性肿瘤患者行病灶刮除＋自体髂骨植骨术.结果 19例均获随访,时间1年3个月～4年,平均2.7年.患者术后6～9个月植骨融合,无股骨头坏死或塌陷,肿瘤无复发征象.结论对股骨头颈部良性肿瘤及瘤样病变采用病灶清除＋植骨可取得良好效果.     

脊椎骨巨细胞瘤的诊断与治疗

骨巨细胞瘤 (ＧＣＴ)是骨科常见肿瘤之一 ,原发于脊柱者占 2 0 % ,在原发肿瘤中约占 10 % [1] 。由于脊柱解剖结构的复杂性 ,加之ＧＣＴ潜在恶性生物学行为 ,有时令临床医生难以处理。自 1991～ 1998年 ,我们共手术治疗脊椎ＧＣＴ11例 ,总结如下。临床资料　见表 1。表 1　 11例ＧＣＴ患者的临床资料序号性别年龄部位神经症状手术术式随访时间及结果1男 3 0Ｓ3无骶 3以下切除 8年 ,无复发及转移2女 3 1Ｓ4无骶 3以下切除 7年 ,无复发及转移3女 18Ｔ9无刮除植骨后路固定 6年 ,Ｘ像病灶区植骨融合4男 2 9Ｔ4无刮除植骨 5年 ,ＣＴ病灶区大部为…     

刮除植骨治疗骨巨细胞瘤的临床研究

目的：研究骨巨细胞瘤（giant-cell tumor,GCT）刮除植骨的局部复发率和并发症。方法：48例GCT选自1988－1995年我院收治的82例GCT患,采用囊内刮除植骨,进行临床和放射学随访。结果：经过28月－123月随访,功能优良率86．9％,局部复发率16．7。结论：本研究提示辞除植骨复发率低,可能与肿瘤充分刮除有关。     

手部内生软骨瘤16例分析

目的比较掌、指骨内生软骨瘤刮除植骨与单纯刮除术2种治疗方法的结果。方法1986年7月～1997年6月手术治疗掌、指骨内生软骨瘤16例,其中单发性内生软骨瘤10例,多发性内生软骨瘤6例,合并病理性骨折4例。单纯行肿瘤刮除术6例,肿瘤刮除松质骨条填塞植骨10例。结果术后随访15例,随访时间2年～12年6个月,平均6年8个月,肿瘤无一例复发及癌变。结论掌、指骨内生软骨瘤刮除术后可不必植骨,彻底刮除病变组织是防止内生软骨瘤复发的关键。     

骨巨细胞瘤单克隆抗体GCF—5特性及价值的进一步研究

本文是关于本室制备的骨巨细胞瘤（ＧＣＴ）单克隆抗体ＧＣＦ－５系列研究之一。为了进一步揭示它的特性和价值，用Ｆ１ＴＣ（偶联ＧＣＦ－５）、ＰＩ（标记ＤＮＡ）和ＰＥ（偶联抗ＣＤ２单抗）对３０例ＧＣＴ标本进行标记，通过流式细胞仪分析了ＧＣＦ－５与ＧＣＴ中细胞结合的特性。结果显示：瘤细胞ＧＣＦ－５阳性率与Ｓ＋Ｇ２／Ｍ期细胞所占比率呈显著性相关（Ｐ〈０．０５）；在２６例原发瘤与４例复发瘤两组之间，ＧＣＦ－５阳     

手部内生软骨瘤34例治疗分析

内生软骨瘤是手部常见的骨肿瘤。我院自1995～2000年共收治此类病人34例，分别行肿瘤刮除术及刮除植骨术，包括自体骨植骨及异体骨移植材料植骨。现分析如下。１资料与方法１．１一般资料本组34例，男19例，女15例；年龄13岁～57岁。内生软骨瘤单发28例，多发6例。发病部位：以近节指骨及2～4掌骨多见，第一掌骨及末节指骨较少，未见腕骨发病，合并病理骨折4例。依肿瘤X线表现分为：中心型18例，偏心型5例，多中心型7例，混合型3例，巨大型1例。１．２方法本组所有病例均行手术治疗，单纯刮除术4例，肿瘤刮除自体骨植骨术23例，肿瘤刮除以…     

Giant-cell tumour of bone. The long-term results of treatment by curettage and bone graft

Giant-cell tumour of bone (GCT) is a locally benign aggressive tumour. The use of adjuvant agents, such as phenol or liquid nitrogen has been recommended to destroy the remaining tumour cells after curettage, and filling of the defect with methylmethacrylate cement has been advocated. Between 1957 and 1992 we treated 92 patients with a GCT with 50% aqueous zinc chloride solution and bone grafting. Their mean age at the time of surgery was 31 years (15 to 59) and the mean follow-up was 11 years (5 to 31). Twelve (13%) had a local recurrence and one had a wound infection. Two developed degenerative changes around the knee. Eighty-six (93%) achieved good or excellent function. Three had moderate function, and three needed amputation. Our findings indicate that treatment with an aqueous solution of zinc chloride and reconstructive bone grafting after curettage gives good results.     

肢体骨巨细胞瘤复发特征与治疗

目的 总结肢体骨巨细胞瘤复发特征及治疗措施。方法 随访复发性肢体骨巨细胞瘤30例,对其临床表现、影像学特征、病理及治疗方法进行回顾性分析。结果 复发病例大多为病灶刮除术后,3年内复发占73．33％,其中有症状者26例,以局部疼痛、肿胀为主;无症状者4例。影像学主要表现为局部植骨吸收,出现不规则密度减低区,病变范围扩大。组织学检查27例复发后仍呈良性,3例恶变。复发治疗;早期病例行再次病灶清除植骨术17例,其中再复发3例;行瘤段切除关节置换4例、关节融合术3例、截肢术6例,均未再复发。结论 定期随访可以早期发现病灶;早期病例可采用彻底的病灶清除加植骨术,晚期病例可采用瘤段切除人工关节置换或截肢等手术。     

Multifocal metachronous giant cell tumour in bilateral upper limb: a rare case presentation

Giant cell tumour (GCT) of bone is a benign but locally aggressive tumour and accounts for 20 % of all benign bone tumours and 5 % of all bone tumours. Multicentric GCT of bone is a rare entity and has increased prevalence of involvement of the small bones of hands and feet in multicentric GCT. The clinical behaviour in multicentric GCTs tends to be aggressive as in recurrent GCTs. En-bloc resection remains the most successful surgical technique for treating both multicentric and solitary lesions. We report a 14-year-old female patient presenting with metachronous benign GCT located at the right proximal humerus and subsequent lesions in left hand and left proximal humerus. The case was treated with multimodality therapy including en-bloc resection along with bisphosphonate therapy over a period of 5 years.     

Malignant giant-cell tumor of the parietal bone: case report and review of the literature

OBJECTIVE AND IMPORTANCE: Giant-cell tumors (GCTs) are primary bone tumors that involve long bones in 75 to 90% of patients. They seldom develop in the cranium and are very rare in patients older than 60 years of age. A GCT rarely occurs with Paget's disease; when it does, however, it is most commonly associated with the polyostotic form and tends to involve the craniofacial bones. Pagetic GCTs are less aggressive than GCTs that are not associated with Paget's disease. CLINICAL PRESENTATION: We report the case of an 81-year-old woman with a painless left parietal mass and asymptomatic monostotic parietal Paget's disease. INTERVENTION: Surgical resection was performed, and histological examination of the lesion demonstrated Paget's disease with a malignant GCT. An incidental, low-grade, small-cell lymphocytic lymphoma also was noted. The patient experienced local recurrence of the malignant GCT and eventually died after developing pulmonary metastases of the malignant GCT. CONCLUSION: This case is the first reported example of a patient with a malignant GCT of the cranium associated with monostotic Paget's disease. It provides evidence that not all pagetic GCTs in the cranium are benign, as has been reported.     

Giant cell tumor and the skeletally immature patient

Conventional wisdom suggests that giant cell tumor (GCT) does not occur in the skeletally immature individual; however, we believe that GCTs of bone, though rare, do occur in children. We are reporting the occurrence of GCT of bone in three patients who were skeletally immature at the time of their initial presentation. In our review of the reports since 1954 that document this condition, we were also able to find a total of 318 patients, of whom 130 were skeletally immature at the time of their tumor presentation. From the data compiled, we found a 7.5% incidence of GCT of bone in skeletally immature individuals at a mean age of 10.5 years. Based on our review and the experience with our three patients, we believe the diagnosis of GCT of bone should be considered in the differential diagnosis of a destructive lesion of bone in skeletally immature individuals. Giant cell tumor in the skeletally immature is being reported here to better define its incidence and increase awareness of its occurrence. Management options will also be discussed.     

Infected fractures of the distal tibial metaphysis and plafond: achievement of limb salvage with free muscle flaps, bone grafting, and ankle fusion

Infection after fractures of the tibial plafond is a challenging problem that may even result in amputation. The current study evaluates a limb salvage protocol and the associated long term functional outcome in 6 patients (mean age 46 years) who were treated for infection after a fracture of the distal tibial metaphysis and plafond. Our limb salvage protocol included 3 stages: 1) radical debridement and stabilization of the ankle with a bridging external fixator, 2) soft tissue coverage with free muscle flaps, and 3) ankle fusion using iliac crest bone graft for filling the existing defects measuring 4.2 cm on average. At a mean followup of 5.5 years (range, 2-10.5 years), limb-salvage and eradication of infection was accomplished in all extremities. Fusion of the ankle joint was achieved in all patients, with one patient requiring a supplemental bone grafting procedure for delayed healing of the fusion site. All patients are able to walk without assistive devices and five of six patients are pain free. Limb salvage with free muscle flaps, bone grafting, and ankle fusion is a viable option for the treatment of infected tibial metaphysis and plafond fractures.     

Surgical treatment of giant cell tumour of long bone with anhydrous alcohol adjuvant

This study was designed to evaluate the feasibility and effectiveness of the use of anhydrous alcohol as an adjuvant treatment for giant cell tumours (GCTs) of long bone. Between October 1989 and January 2004, 42 GCT patients were treated and followed up for an average of 4.1 years (range 1-13 years). Mean patient age was 34 years (range 17-67 years). After curettage and additional burring, anhydrous alcohol was used as an adjuvant therapy in all patients before the bone defect was filled with bone graft or cement. Four patients (9.5%) experienced local recurrence. There were no alcohol-related complications. Recurrence-free probability was 87.6% at final follow-up (13 years) after index surgery by Kaplan-Meyer analysis. Our data suggest that anhydrous alcohol can be used as an effective safe adjuvant for the treatment of GCT of long bone.     

Giant cell tumor: Curettage and bone grafting

Background:

Curettage and wide resection are accepted methods of treatment of giant cell tumor (GCT) of bone. The success rate with curettage in different reports varies widely. There is a paucity in the literature regarding selection of cases for curettage. Present study is an analysis of outcome of 34 cases treated by curettage and bone grafting.

Materials and Methods:

Thirty-four cases of GCT of bone, 28 fresh and six with recurrence were treated by curettage and bone grafting. All cases of Campanancci grade 1, 2 and grade 3 which on computerized tomography scan showed break in the cortex confined to one surface and cortical break less than one third of circumference were treated by curettage and bone grafting.

Results:

4 (14%) of these lesions treated primarily by us showed recurrence after one and half year.

Conclusion:

Curettage and bone grafting is a reliable method in the treatment of GCT, provided guidelines regarding selection of cases and principles of tumor surgery are strictly adhered to.     

Local recurrences after curettage and cementing in long bone giant cell tumor

Background

Giant cell tumor of bone (GCT) is a benign lesion with great propensity for local recurrence. This study aimed to analyse the rates of local recurrence and its possible predisposing factors in Campanacci’s Grade III and II GCT of long bones following intralesional curettage and bone cementing.

Materials and Methods:

32 cases of either sex with Campanacci’s Grade II (n= 14), and Grade III (n=18) with intact articular surface, operated between 1995 and 2007 in form of intralesional curettage and bone cementing were studied. All the cases were followed up for 2.5-12 years (mean, 6.5), after primary treatment. The mean age at operation was 32.4 years (range, 18.5-40 years). The proximal tibia was involved in 13 cases (40.6%), followed by distal femur (n=11)34.4% distal tibia (n=3) 9.4%, proximal femur (n=2) 3.2% and distal radius (n=3) 9.4%.

Results:

Eleven patients (34.4%) had local recurrence, of which eight were of Campanacci’s Grade III. The mean recurrence time was 14 months (range, 3-34 months). The two-year recurrence-free survivorship was 71.9% (n=23/32). Post-recurrence mean follow-up was 4.2 years (range, 2-6.5 years).

Conclusion:

We observed higher rate of local recurrence with Campanacci’s Grade III GCTs. We recommend selective use of this procedure in Grade III lesions, particularly with extensive soft tissue involvement.     

Giant cell tumour around the foot and ankle

Giant cell tumour (GCT) has been known to behave unpredictably when located in the foot and ankle bones. Involvement of foot and ankle bones is rare and comprises of less than 4% of all the GCTs. Out of 175 cases of GCT documented in the Scottish Bone Tumour Registry, 8 cases arose from foot and ankle. The mean age was 28.8 years (13–47). These included six males and two females. Pain and swelling was the common mode of presentation. All the cases had minimum follow-up of 36 months (36–180) and had definitive treatment within the first 3 months of initial presentation. The Campannacci radiographic staging system was used in grading the tumours. Seven of eight cases had intralesional procedure, while the remaining one had primary below knee amputation. One case had local recurrence within 2 years of the initial treatment requiring further surgery. Five out of seven cases with curettage involved the distal tibia or fibula. We had one recurrence of the three cases involving the tarsal bones, which reflects the difficulty in achieving thorough curettage in small bone tumours.Thorough curettage and bone grafting with adjuvant therapy has a low recurrence rate and should be considered when possible particularly in the long bones. Use of bone cement may be a better option in small bone involvement in view of difficulty in achieving thorough curettage. Regular follow-up helps detect early recurrence.