肢体长骨骨巨细胞瘤个体化外科治疗的中长期临床结果分析

目的:对比个体化改良与常规方案治疗肢体长骨骨巨细胞瘤(GCTB)的临床效果，评估个体化改良方案的可行性。方法:回顾性研究。纳入2005年1月—2017年12月内蒙古医科大学第二附属医院和天津医院两个骨肿瘤中心178例手术治疗的四肢长骨GCTB患者的临床资料，男95例、女83例，年龄8～75(35.7±11.7)岁。17...

Long-term clinical results of surgical treatment in 178 cases of giant cell tumor of limb long bone

Objective To compare the effectiveness of individualized modified and conventional therapies in the treatment of the giant cell tumor of the long bone of extremities and evaluate the feasibility of the individualized modified regimen.Methods The clinical data of patients with long-bone giant cell tumour of bone(GCTB)of extremities treated by surgery in the Second Affiliated Hospital of Inner Mongolia Medical University and two bone tumor centers of Tianjin Hospital from January 2005 to December 2017 were included. A total of 95 males and 83 females aged 8-75(35.7±11.7) years were included. From January 2005 to December 2011, 70 cases (39 males and 31 females aged 8-68 years) were treated with routine curettage, bone cement, allogeneic bone or autogenous bone filling, and tumor segment resection and artificial prosthesis reconstruction, which were divided into routine group. From January 2012 to December 2017, according to the location of tumor, Campanacci grade, pathological fracture, modified intralesional grinding with bone cement and or allogeneic bone or autogenous bone filling, and tumor segment resection and artificial prosthesis (knee joint improved prosthesis) reconstruction were divided into individualized improved scheme group (improved group), 56 males and 52 females, aged 16-75 years. The observation indicators were as follows: postoperative complications, postoperative recurrence and metastasis and 5-year cumulative relapse-free survival rate between the two groups, and the International Musculoskeletal Tumor Society (MSTS) score at the last follow-up to compare the limb functions of the two groups after surgery.Results All patients completed the operation successfully. No significant difference was observed in the baseline data of the two groups (all P values＞0.05). All patients were followed up for 24-117(56.9±26.1) months. (1) In this study, there were 15 patients with postoperative complications, including 11 patients in the routine group (15.7%, 11/70) and 4 patients in the improved group (3.7%, 4/108), were observed. The incidence of complications in the routine group was significantly higher than that in the improved group and occurred in patients with segmental resection and joint reconstruction (χ²=7.939, P＜0.05). (2) Among 178 patients, 24 (13.5%) had recurrence. The postoperative recurrence rates in the conventional and the improved groups were 22.9% (16/70) and 7.4% (8/108), respectively, and the difference was statistically significant (χ²=8.691, P＜0.05). The recurrence rate of the conventional curettage was 27.3% (15/55) in the routine group and 7.4% (7/95) in the improved group. The difference between the two groups was statistically significant (χ²=11.027, P＜0.05). In the two groups, one patient had recurrence after resection and reconstruction (P＞0.05). The recurrence rate of the distal radius and the proximal femur in five cases (5/12), and the overall recurrence rate in both groups was 13.5%(24/178). The 5-year cumulative relapse-free survival rate of 178 patients was 90.8% (78.5%, routine group; 91.2%, improved group). The difference between the two groups was statistically significant (χ²=5.923, P＜0.05). (3) The MSTS score of the postoperative limb function in 178 patients was (28.7±2.3) points. The MSTS scores of the contrast ([27.61±3.13] points) and the improved ([29.33±1.29] points) groups were significantly different (t=4.365, P＜0.01). In both groups, the MSTS score after curettage was significantly higher than that after resection and reconstruction (t=5.620, 2.177, respectively; all P values＜0.05).Conclusions The giant cell tumor of bone patients treating with individualized modified therapies can receive low recurrence rate and improve postoperative function. The segmental resection combined with the modified prosthesis reconstruction can improve the joint function and reduce the postoperative complications.