瘤腔内钢板支撑联合骨水泥填充重建膝关节周围骨巨细胞瘤扩大刮除后骨缺损

目的 探讨膝关节周围骨巨细胞瘤扩大刮除后,应用锁定钢板内置于瘤腔支撑固定联合骨水泥充填骨缺损的临床效果.方法 回顾2007年2月至2011年2月,本组收治的膝关节周围CampanacciⅡ级骨巨细胞瘤16例,男7例,女9例,年龄21～43岁,平均29.3岁,其中初发12例,复发4例.手术采用扩大刮除、锁定钢板内置瘤腔支撑固定联合骨水泥充填重建骨缺损的方法,术后早期负重功能锻炼.结果 本组病例依照Jaffe组织学分级Ⅰ级5例、Ⅱ级11例,所有病例术前CT均显示瘤体较大,骨质破坏直径超过1/2骨直径,未穿破关节软骨,无病理性骨折,本组患者术后早期恢复良好,无出现严重并发症,1例术后伤口表浅感染,经换药后愈合,所有病例均随访2年以上,肿瘤复发2例（12.5%）,未出现关节面塌陷、骨折等并发症.肢体功能按Enneking评分平均（27±1.34）分.结论 对瘤体巨大并侵犯软骨下骨,骨强度及关节面稳定性受严重破坏的初发或复发性邻膝关节骨巨细胞瘤应用钢板内置的方法能增强骨水泥套的支撑力和骨强度,一定程度上避免行瘤段切除关节重建,减少术后骨折、关节面塌陷等远期并发症发生,利于关节功能恢复.

Plate fixation combined with bone cement reconstructs bone defect after extended curettage for giant cell tumor arround knee joint

Objective To assess the clinical outcomes of intralesional plate fixation combined with bone cement filling to reconstruct the bone defect after the extended curettage for the giant cell tumor arround the knee joint. Methods During February 2007 to February 2011, 16 cases of Campanacci Ⅱ giant cell tumor arround the knee joint in our hospital were retrospected, There were seven males and nine females. The average age was 29.3 （range 21 to 43） years. The primary and recurrent cases were 12 and four respectivley. The surgery was carried out using intralesional plate fixation combined with bone cement to fill and reconstruct the bone defect after the extended curettage for tumor. Early postoperative systematic function exercises were performed after the operation. Results According to Jaffe classification, there were five of grade Ⅰ and 11 of grade Ⅱ. All the tumor presented huge volume in CT scan and the diameter of the lesion was more than 1/2 of the normal bone. The destruction of the articular cartilage and the pathological fracture were not found. All the patients recovered well after surgery and no severe complication occurred. Only one patient developed the infection of the incision and healed properly after changing the dressing. All the eases were followed up for more than two years. The recurrence rate was 12. 5% ; no collapse of the articular surface or bone fracture were found. The average function score was （27 ± 1.34） according to Enneking score system. Conclusion Intralesional plate fixation combined with the bone cement filling could enhance the bracing force of the cement and the bone strength, reduce the long-term complications after the operation （bone fracture and collapse of the articular surface）, facilitate the recovery of the joint function and avoid the tumor segment resection knee prosthesis in a certain extent.