瘤体骨切除灭活再植一期骨关节重建治疗膝部巨细胞瘤

体内刮除及灭活植骨治疗膝部巨细胞瘤(GCT)的复发率高。作者自1991年1月采用瘤体骨切除,离体灭活再植,与骨残端体内灭活相结合。骨缺损采用自家腓、髂骨移植,L-梯形加压钢板(L-TCP)或梯形加压钢板(TCP)固定、治疗膝部GCT 13例,其中8例保留关节,5例做膝关节融合。本组无菌创口感染1例,1例复发恶变做截肢。在保留关节的8例中7例关节功能恢复优良,1例差。表术式疗效确实,复发率低。保留关节术式适于关节破坏较轻(≤1/2)者,结舍关节残端体内灭活和有效的骨结构重建,有利恢复关节功能。如关节面累及>1/2,宜做骨关节端切除,灭活再植,关节融合或人工关节置换术。

TREATMENT OF GAINT CELL TUMOR AROUND KNEE BY REPLANTATION OF DEVITALIZED RESECTED BONE AND RECONSTRUCTION OF BONE AND JOINT AT ONE STAGE

The recurrant rate of GCT after curettage and devitalization in vivo is still very high. Since January 1991, 13 cases with GCT around knee have been treated by resection of the tumor bone, which was replanted after curettage and devitalizing in 75% alcohol. The bone defect was repaired with autogenous fibular and iliac bone graft, and fixed with a L-compression plate ( L - TCP) . The tumor located at distal femur 10 cases and proximal tibia 3 cases. The joint was preserved in 8 cases, and arthrodesis was performed on 5 cases. Wound infection occurred in one of those were cleanly incised. Reccurrance established in only one case grade ID . The function of the joints rated excellent and good in 7 cases, rated poor in one. The results demonstrated that the effect of replantation of tumor bone devitalized in vitro is more reliable. The re-currant rate was much less. The joint can be pressrved in those cases when the articular surface is involved less than 1/2. Otherwise, joint fusion or artificial joint replacement is indicated.