肢体骨巨细胞瘤复发特征与治疗

目的 总结肢体骨巨细胞瘤复发特征及治疗措施。方法 随访复发性肢体骨巨细胞瘤30例，对其临床表现、影像学特征、病理及治疗方法进行回顾性分析。结果 复发病例大多为病灶刮除术后，3年内复发占73．33％，其中有症状者26例，以局部疼痛、肿胀为主；无症状者4例。影像学主要表现为局部植骨吸收，出现不规则密度减低区，病变范围扩大。组织学检查27例复发后仍呈良性，3例恶变。复发治疗；早期病例行再次病灶清除植骨术17例，其中再复发3例；行瘤段切除关节置换4例、关节融合术3例、截肢术6例，均未再复发。结论 定期随访可以早期发现病灶；早期病例可采用彻底的病灶清除加植骨术，晚期病例可采用瘤段切除人工关节置换或截肢等手术。

Features and treatment of recurrent giant cell tumor of limbs

Objective To summarize the features and treatment of recurrent giant cell tumor(GCT) of limbs. Methods Clinical, radiological, pathological data and treatment of 30 cases of recurrent GCT of limb were analyzed. Results Most of the recurrent cases of GCT of limbs were 3 years after operation of curettage. 26 cases had clinical symptoms such as pain,swelling, 4 cases had no symptom. Most of the X ray pictures showed that the bony graft was absorbed, the irregular low density area formed, and the area of tumor enlarged. 27 cases showed benign and 3 cases malignant pathological change. 17 cases in all 30 cases were treated by the operation of curettage and bone grafting. Excision of bone tumor and artificial joint replacement in 4 cases, arthrodesis in 3 cases, amputation in 6 cases. Conclusion The regular follow up must be conducted after first operation of GCT. Curettage of bone tumor and bone grafting can be considered for the early recurrent case. Excision of bone tumor and artificial joint replacemant or amputation will be performed in patients of late stage.