酒精灭活瘤段骨复合假体治疗膝关节周围骨巨细胞瘤的中期随访研究

 目的 探计膝关节周围骨巨细胞瘤整块切除，酒精灭活瘤段骨复合假体重建的手术技术及预后。方法 2007年1月至2008年10月，对8例膝关节周围Campanacci Ⅲ级骨巨细胞瘤患者采用肿瘤整块切除，酒精灭活瘤段骨复合假体重建，男5例，女3例；年龄20~40岁，平均31岁。股骨远端5例，胫骨近端3例。4例为原发肿瘤、余4例为复发病例，其中2例伴有病理性骨折。术后根据国际骨肿瘤协会(Musculoskeletal Tumor Society， MSTS)“骨与软组织肿瘤术后功能重建的评估标准”进行肢体功能评估。根据国际保肢学会(International Society of Limb Salvage，ISOLS)影像评分标准(复合移植)进行影像学评估。结果 随访38~67个月，平均54个月，未出现复发、转移、假体松动等。灭活骨与宿主骨平均愈合时间5.5个月。随访末期，MSTS评分为25~29分，平均为26.3分(88%)，ISOLS复合移植评分为28~35分，平均为32.8分 (88.5%)。1例术后3个月局部疼痛，X线片显示宿主骨-灭活骨有轻微骨吸收，非负重功能锻炼，术后6个月复查骨吸收消失。“爬行替代”可能是酒精灭活骨复合假体重建的主要骨愈合方式，股骨病例的愈合时间略快于胫骨病例。结论 对于膝关节周围Campanacci Ⅲ级骨巨细胞瘤，采用整块切除并酒精灭活瘤段骨复合假体重建可以取得满意的临床效果。

Clinical outcome of alcohol-inactivated autograft-prosthesis composite for aggressive giant cell tumor of bone around the knee

Objective To investigate technique and effect of reconstruction with alcohol-inactivated autograft-prosthesis composite after en bloc resection of giant cell tumor of bone around the knee. Methods From January 2007 to October 2008, 8 patients with Campanacci grade Ⅲ giant cell tumor of bone around the knee underwent en bloc resection of tumor and reconstruction with alcohol-inactivated autograft-prosthesis composite in our hospital. There were 5 males and 3 females, aged from 20 to 43 years (average, 31 years). The tumor located in distal femur in 5 cases and proximal tibia in 3 cases. There were 4 cases of primary tumor and 4 cases of recurrent tumor. Two patients combined with pathological fracture. The Musculoskeletal Tumor Society (MSTS) score was used to evaluate limb function, and the International Society of Limb Salvage (ISOLS) score was used for radiographic evaluation. Results All patients were followed up for 38 to 67 months (average, 54 months). No recurrence, metastasis, prosthesis loosening were found. The mean healing time of autograft and host bone was 5.5 months. At final follow-up, the MSTS score ranged from 25 to 29 average, 26.3 (88%)]; the ISOLS score ranged from 28 to 35 average, 32.8 (88.5%)]. Creeping substitution was possibly the main way of bone union. The healing time in femoral lesion was faster than that in tibial lesion. Conclusion For Campanacci grade Ⅲ giant cell tumor of bone around the knee, en bloc resection and reconstruction with alcohol-inactivated autograft-prosthesis composite is an effective method, which can provide satisfactory results.