不同辅助灭活方式对初治CampanacciⅠ级、Ⅱ级骨巨细胞瘤患者复发率的影响

目的探讨不同辅助灭活方式对初诊CampanacciⅠ级、Ⅱ级骨巨细胞瘤患者治疗后复发率的影响，以指导临床工作。方法对2005年1月至2011年12月期间由我中心收治的75例确诊为CampanacciⅠ级或Ⅱ级四肢骨巨细胞瘤的初治患者进行随访及随访资料回顾性分析，75例患者中共有54例获得随访，随访率为72％。其中门诊随访40例，电话随访和信访14例；男30例，女24例；年龄12～50岁，平均30．6岁。平均随访时间是50．6个月。治疗方法主要包括：A：病灶刮除、植骨术；B：病灶刮除、灭活、植骨术。灭活方式有高速磨钻、骨水泥、电刀烧灼、液氮、酒精。随访内容包括：（1）单纯刮除植骨术与刮除、灭活植骨术对术后复发率的影响；（2）辅助灭活方法在降低复发率中的作用；（3）不同辅助灭活方式对术后复发率影响的比较。应用SPSSl3．0软件对数据进行统计学分析。结果（1）9例采取病灶刮除、植骨术的患者复发5例，复发率为55．6％；45例采用病灶刮除、灭活、植骨术的患者复发7例，复发率为15．6％；（2）不同灭活方法都可以降低复发率，但不同辅助灭活方式比较，得出只有高速磨钻在使用和不使用时的复发率是有差别的，液氮、酒精、电刀烧灼及骨水泥之间差异无统计学意义。结论（1）灭活方法及其联合使用可以明显降低复发率。但是对其作用单独进行分析，只有高速磨钻达到统计学意义，其他的4种灭活方法都可以不同程度降低复发率，但其差异无统计学意义；（2）对初诊CampanacciⅠ级、Ⅱ级骨巨细胞瘤患者，为减少复发，应根据本医院具体情况，积极联合应用多种辅助灭活方式。

Effects of the initial treatment of different kinds of adjuvant inactivation on the recurrence rate in the patientswith Campanacci grade I or II giant cell tumor of bone

Objective To investigate the effect of the initial treatment of different kinds of adjuvant inactivation on the recurrence rate in the patients with Campanacci grade Ⅰ or Ⅱ giant cell tumor of bone, and further to guide the clinical work. Methods From January 2005 to December 2011, 75 patients who were diagnosed as Campanacci grade Ⅰ or Ⅱ giant cell tumor of bone in limbs were initial treated at our center. Among them, 54 patients were followed up successfully, with the follow-up rate of 72% and the mean follow-up period of 50.6 months, and the follow-up data were retrospectively analyzed. 40 patients were followed up in the outpatient department and 14 by telephone or letter. There were 30 males and 24 females, with the mean age of 30.6 years old （range; 12-50 years）. The surgical options included： A： intralesional curettage and bone graft; B： intralesional curettage, inactivation and bone graft, and the inactivation including high speed drill, bone cement, electric cauterization, liquid nitrogen and alcohol. The follow-up study included： （1） The effect of simple curettage and bone graft and curettage and inactivated bone graft on postoperative recurrence rate; （2） The function of adjuvant inactivation in decreasing the recurrence rate; （3） The comparison of the effect of different kinds of adjuvant inactivation on postoperative recurrence rate. The results were evaluated using the statistical software Statistical Package for the Social Science （SPSS） 13.0. Results （1） 5 of 9 patients who were treated with intralesional curettage and bone graft recurred, and the recurrence rate was 55.6%. 7 of 45 patients who were treated with intralesional curettage, inactivation and bone graft recurred, and the recurrence rate was 15.6%; （2） Different kinds of inactivation could decrease the recurrence rate. However, only the differences in therecurrence rate between the patients treated with high speed drill and those who did not receive such treatment were statistically significant. The differences in the recurrence rate between the patients treated with liquid nitrogen, alcohol, electric cauterization or bone cement and those who did not receive such treatments were not statistically significant. Conclusions （1） The use of adjuvant inactivation alone or combinations can obviously decrease the recurrence rate. However, when compared respectively, the differences are statistically significan, only when high speed drill is used. The other 4 adjuvant inactivation can also decrease the recurrence rate in different degrees, while the differences are not statistically significant; （2） In order to reduce the recurrence rate, for the patients with Campanacci grade Ⅰ or Ⅱ giant cell tumor of bone, the initial treatment of different kinds of adjuvant inactivation should be actively used in combination based on the specific situation of the hosoital.