骨骺闭合前骨巨细胞瘤的诊断和治疗

摘要

Objective To demonstrate the common characteristics of giant cell tumor of bone in immature skeletons.Methods From 1989 to 2009,the 8 skeletal immature patients were pathologically diagnosed with giant cell tumor (GCT) in our department,which accounted for 1.3％ (8/621) of all GCT patients in an extremity.All patients were identified with an open epiphyseal plate by retrospective review of the radiograph,CT or MRI by senior consultants.Oncological and functional outcome were followed for a mean 44.1 months.There were 5 boys and 3 girls.The mean age was 13.8 years.All cases had a primary lesion.The distal femur is the most common site involved (3 cases),followed by the proximal tibia (2 cases).The proximal humerus,the distal tibia and the distal radius accounted for 1 case respectively.Oncological and functional outcome are followed for a mean 44.1 months.Results All lesions were lytic.Six lesions involved both the epiphysis and metaphysis.Two lesions located in the metaphysis area.Six lesions were treated with extended curettage and were reconstructed with allograft and (or) bone cement.Internal fixations were used in 2 cases.Two cases were treated with segmental resection.And one was reconstructed with cement spacer and the other one with segmental allograft and internal fixation.One patient (1/6) developed a bone recurrence after extended curettage.No extremity deformity and discrepancy were found during the follow up after the curettage.No metastasis was found during the follow up.Conclusion Histologically GCT occurs in skeletal immature bone has the same pathological appearance but radiologically has its unique features.These lesions share same behavior as that in adults.A low local recurrence rate and good function can be achieved after a proper surgery.%目的 探讨发生于骨骺闭合前的骨巨细胞瘤的临床特点.方法 收集1989-2009年骨巨细胞瘤患者的临床资料,根据其影像学资料筛选出8例发生于骨骺闭合之前的骨巨细胞瘤患者,其中男性5例,女性3例,平均年龄13.8岁,病灶位于股骨远端干骺端3例,胫骨近端干骺端2例,肱骨近端干骺端、胫骨远端干骺端和桡骨远端干骺端各1例.分析8例患者的临床治疗及随访情况.结果 8例患者病灶均呈溶骨性改变,其中6例病灶穿透骺板累及骨骺,Campanacci分级均为2级.2例患者接受瘤段截除关节重建手术,6例行扩大刮除手术,其中1例复发.7例患者获得随访,随访时间24 ～70个月,行刮除术的患者中没有出现肢体发育畸形或肢体不等长,未出现转移病例.结论 发生于骨骺闭合前的骨巨细胞瘤的生物学行为与病理学表现与发生于骨骺闭合后的骨巨细胞瘤相似,但影像学表现不同.适当的外科治疗可实现良好的局部控制和肢体功能的恢复.