股骨近端骨巨细胞瘤治疗的多中心回顾性研究

摘要

目的 回顾性分析股骨近端骨巨细胞瘤的发病特点、治疗方法及疗效,探讨不同手术方式的适应证及注意事项,分析复发及影响肢体功能的危险因素.方法 收集1991年11月至2012年6月全国4个骨肿瘤治疗中心临床资料完整的43例股骨近端骨巨细胞瘤患者的病例资料,将其中初次治疗、随访时间超过2年的28例患者纳入研究,男19例,女9例;首诊时平均年龄(28.7±8.8)岁.按照骨肿瘤国际保肢协会(International Society of Limb Salvage,ISOLS)股骨近端的分区方法,H1区2例,H2区20例,H1+H2区6例.Campanacci分级Ⅱ级22例、Ⅲ级6例,其中7例合并病理性骨折.初次手术采用扩大刮除术21例,整块切除重建术7例.分析影响手术方式选择、复发及肢体功能的因素,包括发病部位、Campanacci分级、病理性骨折及手术方式.结果 全部患者术后均得到随访,随访时间25～273个月,平均(69.8±50.3)个月.行刮除术的21例患者中2例(9.5％)局部复发,行整块切除的7例患者均无复发.病理性骨折及Campanacci分级是影响手术方式选择的因素.手术方式、病理性骨折、Campanacci分级与患者的局部复发率无相关性.采用刮除重建的患者术后功能优于行整块切除重建者.结论 股骨近端骨巨细胞瘤主要侵犯股骨颈及转子部,与膝关节周围骨巨细胞瘤相比发生病理性骨折的风险高.整块切除重建术的适应证为合并病理性骨折或CampanacciⅢ级的患者.通过不同手术入路充分显露、刮除病灶,合理的预防性内固定可以降低刮除术后的复发率和并发症.%Objective To retrospective analysis the onset characteristics and outcome of surgical management in patients with giant cell tumor (GCT) of proximal femur,explore the operation indication and the risk factors for recurrence and limb function.Methods From November 1991 to June 2012,43 patients with GCT in the proximal femur from domestic four bone tumor centers were involved,among which 28 patients were enrolled in this study,including 19 males and 9 females,with an average age of (28.7±8.8) years.According to International Society of Limb Salvage (ISOLS),there were 2 cases in H1,20 cases in H2,and 6 cases both in H1 and H2.There were 22 cases of Campanacci Ⅱ,6 cases of Campanacci Ⅲ,and 7 cases with pathologic fracture.The primary surgical treatment included extensive curettage in 21 cases and resection in 7 cases.The risk factors affecting selection of surgical manners,tumor recurrence,and functional outcomes were analyzed.Results All patients were followed up with a mean duration of (69.8±50.3) months,ranging from 25 to 273 months.The local recurrence rate was 9.5％ for patients treated with intralesional curettage,0％ for marginal excision.Pathological fracture,Campanacci grades had a significant influence on the selection of surgical manners.Types of surgery,pathological fracture,Campanacci grades were not the risk factors for recurrence.The postoperative function of curettage group was better than the marginal excision group.Conclusion GCT of proximal femur are most commonly seen in femoral neck and intertrochanteric part,whose fracture risk is high.Patients with pathological fracture or Campanacci grade Ⅲ need en bloc resection and reconstruction.Fully revealed lesions,extensive curettage and reasonable preventive application of internal fixation could improve the success rate of intralesional curettage.