距骨原发肿瘤的诊断与治疗

目的 探讨距骨原发肿瘤的发病特点﹑外科治疗和预后.方法 回顾性分析1993年1月至2008年12月我科收治的21例距骨原发肿瘤及瘤样病变,从临床、影像和病理分析距骨肿瘤特点,所有病例均进行外科治疗,术后随访按肌肉骨骼系统肿瘤协会(MSTS)标准进行功能评分.结果 21例患者中软骨母细胞瘤10例,骨巨细胞瘤7例,骨样骨瘤、动脉瘤样骨囊肿、单纯骨囊肿、骨纤维结构不良各1例.10例软骨母细胞瘤发病年龄为10～35岁,平均22岁.均行病灶刮除,1例骨水泥填充,9例植骨.9例完整随访均无复发.随访时间为15-87个月,中位随访时间为36个月,功能评分均为30分.7例骨巨细胞瘤发病年龄为20～33岁,平均24岁.影像学均为溶骨性破坏,基质无钙化.4例原发病例,均行病灶刮除术.3例复发病例,2例行距骨切除跟骨胫骨融合术,1例行小腿截肢术.3例完整随访,2例为原发病例,术后10个月和32个月未复发;另1例为复发病例,随访36个月未复发,功能评分分别为29、26和24分.4例其余诊断病例,1例骨样骨瘤行局部切除植骨术,另外3例均行病灶刮除植骨术,术后随访均无复发.结论 距骨好发肿瘤为软骨母细胞瘤和骨巨细胞瘤.距骨软骨母细胞瘤特点:患者发病年龄较大,病灶内钙化提示诊断,刮除植骨术可获得满意治疗效果.距骨骨巨细胞瘤特点:常累及全距骨,病灶刮除有较高复发率,距骨切除可降低局部复发率,但是遗留部分功能障碍.

Diagnosis and treatment for primary bone tumor of the talus

Objective To analyze the clinical feature, surgical treatment and prognosis of primary bone tumor of the talus. Methods From January 1993 to December 2008, 21 patients of primary bone tumor and tumor-like lesion in the talus were retrospectively analyzed. The feature of bone tumor of the talus was analyzed from clinical, imaging and pathological aspects. All patients underwent surgical treatment. During postoperative follow-up, the function of patients was evaluated according to the criteria of musculoskeletal tumor society （MSTS）. Results In all 21 patients, there were chondroblastoma （10 cases）, giant cell tumor of bone （7 cases）, osteoid osteoma （1 case）, aneurysmal bone cysts （1 case）, simple bone cysts （1 case）, and osteofibrous dysplasia （1 case）. Among 10 patients with chondroblastoma, the mean age was 22 years old （range; 10-35years）. All 10 patients were performed curettage. 1 patient was performed curettage and filled with bone cement. 9 patients were performed curettage and bone grafting. No recurrence appeared among 9 patients with complete follow-up. The follow-up lasted for 15-87 months, and the median follow-up was 36 months. The function score （MSTS） was all 30. The mean age of onset of 7 patients with giant cell tumor of bone was 24 years old （range; 20-33years）. Through image text, all cases suffered osteolytic damage. No calcification existed in ground substance. 4 patients were primary cases and conducted curettage. 3 cases relapsed. 2 cases were performed astragalectomy and fusion of calcaneus and tibia. 1 patient was applied crus amputation. 3 patients had complete follow- up, and 2 patients were primary cases. Postoperatively, no recurrence happened within 10 and 32 months respectively. Recurrence happened in 1 case. No recurrence happened in follow-up lasting for 36 months. The function scores were respectively 26, 29 and 24. For other four patients with diagnosis, 1 patient with osteoid osteoma received lesion resection and bone grafting and 3 patients received curettage and bone grafting. Postoperative follow-up showed that no relapse happened. Conclusions The most common bone tumor in talus are chondroblastoma and giant cell tumor. The features of chondroblastoma in talus are： the age of patient with chondroblastoma in talus was older than that in other site, calcification within lesions help diagnosis, and curettage and bone grafting could get satisfactory result. The features of giant cell tumor in talus： whole talus was always involved, curettage for giant cell tumor had high recurrence rate, and astragalectomy could lower partial recurrence rate, while remaining part was of dysfunction.