长骨巨细胞瘤的外科治疗策略：113例分析

目的探讨不同手术方式对长骨巨细胞瘤患者的治疗效果。方法回顾分析1995年1月。2006年12月在我院骨科行手术治疗的长骨巨细胞瘤患者113例。Campanaeei Ⅰ级17例，Ⅱ级58例，Ⅲ级38例。行囊内刮除术87例，其中囊壁处理使用苯酚22例，无水酒精46例，50％氯化锌19例。行囊外切除术26例。平均随访时间70．2个月（24～125个月）。结果刮除组共复发23例，切除术组复发2例。刮除组不同囊壁处理方式复发率差异无显著性意义（P=0．474）。Campanacci Ⅲ级患者刮除术组和切除术组复发率差异有显著性意义（P=0．015）。术后MSTS评分刮除组为26．5±2．9分，优良率97．2％。切除组为23．3±4．8分，优良率为85．4％。两组评分差异有显著性意义（P=0．006）。结论长骨巨细胞瘤患者应根据影像学分级，术后功能要求等不同因素个体化选择外科治疗方式。

Surgical treatment of giant cell tumor in the long bones: a report of 113 cases

Objective To investigate the clinical outcomes of different surgical treatments of giant cell tumor in the long bones. Methods A retrospective analysis was done on 113 cases who underwent surgical treatment for giant cell tumor in the long bones from January 1995 to December 2006. According to Campanaeci grading system, the classification was grade Ⅰ （n=17）, grade Ⅱ （n=58）, and grade Ⅲ （n=38）. A total of 87 patients underwent intracystic curettage. The cyst wall was treated with phenol in 22 patients, anhydrous ancohol in 46 patients, and 50% zinc chloride in 19 patients. A total of 26 patients underwent extra-capsular resection. The mean follow-up was 70.2 months, ranging from 24 to 125 months. Results Twenty-three patients who underwent curettage had recurrence. Two who underwent resection had recurrence. The different treatments of the cyst wall in the curettage group had no statistical significance （P=-0.474）. The outcomes of patients of Campanacci grade Ⅲ showed significant difference between curettage and resection （P=-0.015）. The post-operative MSTS score and excellent rate was 26.5±2.9 and 97.2% in the curettage group, whereas was 23.3±4.8 and 85.4% in the resection group. The scores showed significant difference （P=0.006）. Conclusions The surgical treatment of giant cell tumor of long bones should be determined according to the grading and functional requests.