376例膝关节周围骨巨细胞瘤的临床特征分析

 目的 总结膝关节周围骨巨细胞瘤（giant cell tumor，GCT）的临床特征及影像学特点。方法 回顾性分析中国骨巨细胞瘤协作组（天津医院、济南军区总医院、西京医院、浙医二院、南京军区总医院）2000年3月至2014年7月间所有膝关节周围GCT患者的临床及影像学资料，按性别、年龄、发生部位、Campanacci分级、Ennecking分期、周围软组织受侵袭情况、病理性骨折程度和手术方式分别进行统计，分析膝关节周围GCT的临床特征。结果 共收集376例GCT患者，原发302例，复发74例；男198例，女178例；发病年龄12~78岁，平均（35.6±12.8）岁，男性发病平均年龄（37.4±13.2）岁，女性发病平均年龄（33.5±12.0）岁，女性发病年龄明显低于男性，差异有统计学意义。左膝关节175例（46.5%）、右膝关节201例（53.5%），差异无统计学意义。股骨远端202例（53.7 %）、胫骨近端174例（46.3%），差异无统计学意义。瘤体破坏偏心性304例（80.9%），中心性72例（19.1 %）。未发生骨折261例（69.4%），简单骨折73例（19.4%），复杂骨折42例（11.2%）。结论 膝关节周围骨巨细胞瘤临床特征及影像学特点在不同年龄组、不同性别间存在差异，Campanacci影像学分级越高，其病理性骨折的发生率、囊外病变比例及采取边缘切除方式的比例就越高。

Clinical characteristics of giant cell tumor around knee: 376 cases report

Objective To explore the clinical and imaging characteristics of giant cell tumor around the knee and to improve the level of diagnosis through analyzing the epidemiological and radiological features. Methods The data of 376 patients with giant cell tumor around the knee who underwent surgical treatment in Giant Cell Tumor Team of China (GTOC) were collected from March 2000 to July 2014, to record clinical characteristics including gender, age, position and radiological features. A multicentric study was applied to analyze the epidemiological features of giant cell tumor around the knee. Results Primary group of 302 cases and recurrent group of 74 cases developed an integrated study group of 376 cases, including 198 males and 178 females. The mean age of the whole study group was 35.6±12.8 years old (range, 12-78 years old). The mean age of female group was 33.5±12.0 years old which was younger than male group, with a mean age of 37.4±13.2 years old. 175 cases (46.5%) occurred in the left knee joint, which was less than the right side consisting of 201 cases (53.5%)，and there was a statistical significance between them. There were 202 cases (53.7%) that located in distal femur and 174 cases (46.3%) in proximal tibia, between which there was no statistical significance. In the whole study group, 72 cases (19.1%) were found to have a centricity growth of giant cell tumor, which were remarkably less than non-centricity growth group of 304 cases (80.9%). There were 261 (69.4%) cases without fracture, 73 cases (19.4%) with simple fracture and 42 cases (11.2%) with complex fracture, which showed statistical significance between them. Conclusion Clinical and imaging characteristics of giant cell tumor around the knee are different in various areas and between different genders. It is generally agreed in our study that with a higher imaging grading according to the system of Campanacci, the risk of pathological fracture, the proportion of extra-capsular lesions, and the rate of surgical selection of segmental resection are all higher.