摘要
目的评价手及足部骨巨细胞瘤瘤段切除后行自体髂骨重建内固定的临床疗效。方法 1997年8月-2008年4月,收治手及足部骨巨细胞瘤8例。其中男3例,女5例;年龄16～42岁,平均28.5岁。肿瘤部位:掌骨3例,跖骨4例,趾骨1例。X线片根据Campanacci标准分级:Ⅰ级1例,Ⅱ级7例。术前病理检查分级:Ⅰ～Ⅱ级3例,Ⅱ级4例,Ⅱ～Ⅲ级1例;肿瘤TNM分期:TisN0M01例,T1N0M04例,T2N0M03例。其中初发6例;复发2例,初次手术均为单纯瘤体刮除植骨,初次手术距复发时间分别为11个月和14个月。肿瘤范围1.8cm×1.0cm～6.0cm×2.0cm;骨皮质变薄,肿瘤与骨膜边界清晰。均行骨巨细胞瘤瘤段切除(包括破坏的骨骼及肿瘤侵及的病变软组织),三面皮质自体髂骨重建、微型钢板内固定。结果术后切口均Ⅰ期愈合。8例均获随访,随访时间10～84个月,平均46个月。X线片示植骨于术后3～9个月融合,平均5个月。移植髂骨均无明显旋转、成角及短缩畸形;供髂骨区功能恢复良好。术中病理检查示均为骨巨细胞瘤;病理分级:Ⅰ～Ⅱ级2例,Ⅱ级5例,Ⅱ～Ⅲ级1例。术后手及足功能恢复,随访期内未见肿瘤复发或肺转移。结论手及足部骨巨细胞瘤瘤段切除自体髂骨重建内固定疗效优良,是一种可靠的治疗方法 。
Objective To evaluate the effectiveness of tumor-segmental resection and autologous iliac bone graft reconstruction combined with internal fixation in treating hand-foot-giant cell tumor of bone. Methods Between August 1997 and April 2008, 8 cases of hand-foot-giant cell tumor of bone were treated, including 3 males and 5 females with an average age of 28.5 years （range, 16-42 years）. The locations were metacarpal bones in 3 cases, metatarsal bones in 4 cases, and phalanges of toes in 1 case. According to Campanacci’s gradation of X-ray films, there were 1 case of grade I and 7 cases of grade II; according to pathological examination before opration, there were 3 cases of grade I to II, 4 cases of grade II, and 1 case of grade II to III; and according to TNM staging, there were 1 case of TisN 0 M 0 , 4 cases of T 1 N 0 M 0 , and 3 cases of T 2 N 0 M 0 . There were 2 cases of recurrence, the time from the first operation to recurrence were 11 and 14 months, respectively. The tumor size was 1.8 cm × 1.0 cm to 6.0 cm × 2.0 cm, the cortical bone became thinner, and the boundary between tumor and periosteum was clear. All patients underwent tumor-segmental resection combined with autologous iliac bone graft reconstruction, and mini-plate internal fixation by lumbar anesthesia or trachea cannula anesthesia. Results All incision healed by first intention. Eight patients were followed up 10 to 84 months with an average of 46 months. Radiographs showed that fracture union was achieved at 3 to 9 months （mean, 5 months）. No significant rotation, angular, and shortening deformity occurred in iliac bone graft. The function of iliac bone donor site recovered excellently. The pathological examination showed giant cell tumor of bone in all cases, including 2 case of grade I-II, 5 cases of grade II, and 1 case of grade II-III. The hand or foot function recovered excellently. No tumor recurrence or lung metastasis occurred during follow-up. Conclusion Tumor-segmental resection combined with autologous iliac bone graft
出处
《中国修复重建外科杂志》
CAS
CSCD
北大核心
2010年第8期922-925,共4页
Chinese Journal of Reparative and Reconstructive Surgery
关键词
骨巨细胞瘤
自体髂骨植骨
重建
内固定
手
足
Giant cell tumor of bone Autologous iliac bone graft Reconstruction Internal fixation Hand Foot
