髌骨骨巨细胞瘤的外科治疗

目的探讨髌骨骨巨细胞瘤的外科治疗效果。方法回顾性分析2004年2月～2009年5月收入我院的1例和外院会诊的3例髌骨骨巨细胞瘤患者的临床资料。其中男性和女性各2例；年龄20～37岁，平均26．8岁；左膝3例，右膝1例。所有患者均以前膝痛为首发症状，X线片显示髌骨溶骨性病变，骨皮质膨胀，边缘硬化。CampanacciⅠ级1例和Ⅱ级2例行病变刮除植骨术，Ⅲ级1例行髌骨全切术。术后病理均确诊为骨巨细胞瘤。结果3例刮除植骨的患者分别随访24、31-162个月，所有患者症状消失，局部无复发，元肺转移，膝关节活动正常，随访X线片显示不同程度的骨融合。髌骨切除的患者通过加强膝关节屈伸和股四头肌功能锻炼，术后13个月除行走稍跛行外，膝关节活动正常。结论对于前膝痛的年轻患者，应警惕髌骨肿瘤的可能性。髌骨骨巨细胞瘤CampanacciⅠ级和Ⅱ级的病变可采用刮除植骨术，Ⅲ级选择髌骨全切术。临床疗效满意。

Surgical treatment of giant-cell tumor of patella

Objective To evaluate the surgical treatment results of giant-cell tumor of patella. Methods Clinical data of 4 patients with patellar giant-cell tumor were retrospectively analyzed. The patients were 2 men and 2 women, aged from 20 to 37 years, 26.8 years in average. Three left knees and one right knee were involved. All patients had pain in the anterior knee as the initial symptom. Plain radiographs demonstrated osteolytic lesion in the patella with cortex swelling or rim sclerosis. Based on Campanacci radiograph grading, the condition was catagorized as stage Ⅰ （n=l）, stage Ⅱ （n=2）, and stage Ⅲ （n=1）, Patients of stage Ⅰand Ⅱ underwent curettage combined with bone graft. The patient of stage III underwent patella resection. Post-operative pathological test confirmed giant-cell tumor. Results Patients of Campanacci Ⅰ and Ⅱ were followed up for 24, 31 and 62 months respectively. All patients showed complete pain relief and no local recurrence or lung metastases. Knee function was normal. Follow-up x-ray indicated bone union of different level. Patella-free patients regained normal knee function with slight claudication through rehabilitation exercise of the knee and quadriceps 13 months after surgery. Conclusions As for younger patients with pain in the anterior knee, patellar tumor should be considered. The majority of patellar tumor is giant-cell tumor of bone. We recommend curettage for Campanacci Ⅰ and Ⅱlesions and total patellectomy for stage Ⅲ.