摘要
目的探讨一种对不同部位、不同骨破坏程度骨巨细胞瘤的个体化治疗选择以及所取得临床结果。方法回顾性分析2005年1月至2014年12月，根据我院采用的骨巨细胞瘤诊疗流程采取大段切除或病灶内刮除（部分加辅助治疗）的方法治疗初发肢体长骨骨巨细胞瘤281例，其中男150例，女131例；年龄14～71岁，平均35．10岁。发病部位：尺骨远端9例，桡骨远端26例，肱骨近端19例，肱骨远端2例，股骨近端38例，股骨远端95例，胫骨近端59例，胫骨远端10例，腓骨近端19例，腓骨远端3例，多发性骨巨细胞瘤1例。病理骨折37例，无病理骨折244例。针对肿瘤发生的不同部位、破坏程度、病理骨折与否，分别采取病灶内刮除和大段切除，并采用骨水泥、异体骨或自体骨、假体等方式重建。采用χ2检验和Cox回归分析检测差异，采用Kaplan-Meier生存分析统计无瘤生存，研究分析肿瘤的部位、破坏程度、Campanacci分级、病理骨折、不同时期的治疗方式与复发之间的关系。结果根据巨细胞瘤诊疗流程，122例接受大段切除，159例接受病灶内刮除（部分加辅助治疗）。所有患者术后复发23例，复发率为8．19％，复发时间为术后9～75个月，平均30．95个月。膝关节周围的病变的复发率与其他部位间无显著性差异（χ2=0．370，P=0．240）。在无病理骨折组中，大段切除组与病灶内手术相比复发率显著较低，差异有统计学意义（χ2=9．393，P=0．002）。在病灶内手术患者中，126例采用骨水泥重建，28例仅采用自体／异体骨重建力学稳定性。骨水泥组复发14例（11．11％），植骨组复发8例（28．57％），骨水泥组复发率显著低于单纯植骨组（χ2=5．846，P=0．017）。横截面〈50％组中4例复发（7．27％），横截面50％～75％组中12例复发（15．79％），横截面破坏〉75％组中4例复发（3．54％）。�
Objective To explore the personalized treatment options and clinical results obtained by our hospital for dif- ferent parts of bone destruction of different degrees of bone giant cell tumor. Methods Retrospective analysis from January 2005 to December 2014, according to the giant bone cell tumor diagnosis and treatment procedures used in thehospital to take wide re- section or intralesional curettage and adjuvant therapy for the treatment of primary limb long bone giant cell tumor 281 cases. There were 150 males and 131 females, with overall age from 14 to 71 years and an average of 35.10 yearsold. The distal ulna was 9 cases.The distal radiuswas 26 cases. The proximal humerus was 19 cases. The distal humerus was 2 cases. The proximal femur was 38 cases.The distal femur was 95 cases. The proximal tibiawas 59 cases. The distal tibiawas 10 cases. There were 19 proximal fibula cases, 3 distal fibula cases and 1 case of multiple giant cell tumor of bone. We chose curettage and/or adjuvant therapy or wide resection, then with bone cement, allograft or autograft, prostheses to reconstructionaccording to tumor site, the degree of de- struction, pathological fractures. The χ2 test and Cox regression analysis were used to detect the statistic differences. The Kaplan- Meier survival analysis was used to count the disease-free survival. The relationship between tumor location, destruction degree, Campanacci grading, pathological fractures, treatment methods at different stages and recurrence were analyzed. Results A total of 281 patients with long bone giant cell tumor were included in the follow-up study, including 37 pathological fracture and 244 non-fracture. According to the author＇s giant cell tumor diagnosis and treatment process, 122 patients received a wide resection, 159 cases were treated with curettage ＋ adjuvant therapy. 23 patients had postoperative recurrence, the recurrence rate was 8.19%. The recurrence time after operation ranged from 9 to 75 months （average 30.95 months）. There was no significant
作者
严晓波
林秾
黄鑫
潘伟波
柳萌
叶招明
Yah Xiaobo;Lin Nong;Huang Xin;Part Weibo;Liu Meng;Ye Zhaoming(The Second Affiliated Hospital of ZheJiang University,Hangzhou 310058,China)
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2018年第18期1116-1125,共10页
Chinese Journal of Orthopaedics
关键词
骨巨细胞瘤
复发
肿瘤治疗方案
Giant cell tumor of bone
Recurrence
Antineoplastic protocols
