复发性肢体骨巨细胞瘤的临床诊治策略

目的]探讨复发性肢体骨巨细胞瘤的临床、影像学特点以及不同治疗方法及临床疗效.方法]自1995年1月～2009年1月治疗29例复发性骨巨细胞瘤,男15例,女14例；复发时平均年龄32.4岁(13～56)岁；股骨远端和胫骨近端各12例,肱骨近端2例,股骨近端、尺骨远端、腓骨近端各1例.首次手术方式与例数:肿瘤刮除植骨26例,瘤段切除骨缺损修复术2例,单纯腓骨近端切除术1例.复发平均时间26.6个月(1～168)个月.再次手术方式与例数:瘤段切除骨缺损修复重建术17例(假体置换14例,自体骨移植2例,灭活再植1例)；肿瘤扩大刮除瘤腔灭活骨修复术7例(植骨4例,骨水泥填充内固定3例),肿瘤扩大切除术3例；截肢术2例.结果]随访时间24～180个月,平均70个月.2例再次复发；总再复发率为6.9％,肿瘤切除骨缺损修复组无复发,病灶内手术组中1例复发(1/7,14.29％),局部扩大切除术组1例复发(1/3,33.33％).随访期内2例死亡(1例死于非肿瘤原因).病灶内手术组肢体功能优良率为100％,瘤段切除骨缺损修复组为73.33％.综合临床疗效评价病灶内手术优良率为85.71％.肿瘤切除骨缺损修复组为66.67％.结论]骨巨细胞瘤术后定期随访对于早期诊断肿瘤复发至关重要；一旦复发诊断明确,尽管存在再次复发的风险,应首选瘤灶内手术；对放射学Companacci Ⅲ级的复发性骨巨细胞瘤可选择瘤段切除骨缺损重建手术治疗,但存在一定的远期并发症.

Clinical diagnosis and surgical treatment on recurrent giant cell tumor of extremity

Objective]To investigate the clinical,radiological manifestations of recurrent giant cell tumor of the bone(RGCT),and the clinical outcomes of different treatments.Method]Twenty-nine patients with RGCT were treated during Jan.1995 to Jan.2009.There were 15 male and 14 female patients.The average age was 32.7 years old(range,13-56 years).Twelve lesions were located at the distal femur and the proximal tibia.Two lesions at the proximal humerus,each at the proximal femur,the distal ulna and the proximal fibu...