双膦酸盐辅助治疗骨巨细胞瘤的临床研究

目的：探讨双膦酸盐作为辅助治疗方法降低四肢骨巨细胞瘤复发率的可行性。方法：２００１年２月～２００７年８月我院及香港中文大学威尔士亲王医院收治的３９例四肢骨巨细胞瘤患者，男性２８例，女性１１例，年龄１８～４５岁。肿瘤影像学分级按Ｃａｍｐａｎａｃｃｉ分级标准，其中Ⅱ级１８例，Ⅲ级２１例。所有患者治疗前均经过病理活检诊断为骨巨细胞瘤。分为治疗组和对照组。对照组２０例患者，未予双膦酸盐治疗。治疗组１９例患者，于手术前给予１～３疗程的双膦酸盐治疗（唑来膦酸４ｍｇ，２～３周１次），术后继续给予３个疗程以上的双膦酸盐治疗。所有患者均接受了手术治疗，手术方式包括囊内切除＋骨水泥或骨移植重建，瘤段切除＋骨移植或人工关节重建。结果：随访１９～３４个月。双膦酸盐治疗后患者疼痛减轻，ＶＡＳ疼痛评分由８.１９±１.３３减轻至２.４２±１.０１，差异有显著性意义（ｔ＝１５.３０４Ｐ＝０.０００）。７８.９％的患者肿胀减轻，６３.２％的患者在唑来膦酸治疗２～３疗程后Ｘ线片上肿瘤内出现明显的骨矿化增加或骨生成。治疗组的复发率为５.３％，低于对照组３５％，差异有显著性意义（χ２＝５.２８４，Ｐ＝０.０２２）。３级骨巨细胞瘤对照组的复发率为５０.０％，治疗组为９.１％，差异有显著性意义（χ２＝４.２９５，Ｐ＝０.０３８）。结论：双膦酸盐作为辅助治疗能够显著降低四肢骨巨细胞瘤的复发率。用药后症状与体征的改善，影像学中骨矿化或骨生成都可作为双膦酸盐疗效的评价方法。

Clinical study of bisphosphonates reducing local recurrence in extremity giant cell tumor of bone

Objective ：To investigate the clinical effect of bisphosphonates as an adjuvants treating giant cell tumor of bone in extremity. Methods：Thirty-nine patients with histological diagnosed appendicular GCT were included from Febuary, 2001 to August, 2005. Intralesional curettage or wide excision of the lesions was followed with cementation or biological reconstruction including bone graft and artificial tumor prosthesis replacement. Additional intravenous bisphosphonates were given peri-operatively to 19 patients of treatment group. The other 20 patients were refined as control group. The average follow-up of the control group was 43.6 months while that of the treatment group was 24. 3 months. Results： All patients reported a reduction in pain. Visual analog pain score improved from an average of 8.19±1.33 to 2.42 ± 1.01, 78. 9% of patients experience subjective decrease in swelling. We noted convincing radiological evidence of mineralization in 63.2% patients after 2-3 cycles bisphosphonates treatment. After 24. 3 （ 19 - 34 ） months of follow- up, 5.3 % recurrence rate in the bisphosphonates treatment group was significantly lower than control group, 35 %. The recurrence rate in patients with III-stage GCT dropped from 50. 0% to 9. 1%. Conclusion：Clinical use of bisphosphonates as an adjuvant therapy for giant cell tumor of bone demonstrated a lower local recurrence rate. The improvement of symptoms and signs after administration of bisphosphonates and radiological evidence of mineralization in X-ray or CT were used as evaluation method on the efficacy of the use of bisphosphonates as an adjuvant.