髌骨肿瘤外科治疗

摘要

目的 评估髌骨肿瘤外科治疗效果进行回顾性分析.方法 回顾性分析2010年5月至2015年12月我院收治的15例髌骨肿瘤患者临床资料,其中14例原发性髌骨肿瘤,1例转移性腺癌.原发性髌骨肿瘤中骨巨细胞瘤(GCT)3例(其中合并动脉瘤样骨囊肿1例),软骨母细胞瘤9例(其中合并动脉瘤样骨囊肿7例),纤维组织细胞瘤1例,血管瘤合并动脉瘤样骨囊肿1例;在所有原发性髌骨肿瘤中Enneking 2期12例,Enneking 3期2例.所有患者中,男7例,女8例;年龄18~66岁,平均年龄31.7岁;左侧7例,右侧8例;因髌骨骨折就诊3例,其余均以前膝疼痛就诊,行髌骨全切除术3例,单纯病灶刮除植骨术10例,病灶刮除植骨内固定术2例.结果 1例(软骨母细胞瘤合并动脉瘤样骨囊肿)失访,14例随访时间6~25个月,平均13.9个月.1例(转移性腺癌)8个月内死亡,其余局部均无复发、转移,膝关节活动度正常,牛津大学膝关节评分(OKS)13~20分,平均15.6分,随访X线检查显示存在不同程度的骨愈合.结论 对于前膝疼痛的患者应早期行X线检查排除髌骨肿瘤,对Enneking 1~2期髌骨良性肿瘤以病灶刮除植骨术为主,对Enneking 3期髌骨良性肿瘤、原发性恶性肿瘤或转移癌则应行髌骨全切除术,本组随访患者术后功能恢复良好,治疗效果满意.%Objective To analyze the outcome of surgical management of patellar tumor.MethodsFrom May 2010 to December 2015,the clinical data of 15 patients with patellar tumors was analyzed retrospectively.Among all of the patients, there were 14 primary patellar tumors and 1 metastatic adenocarcinoma.Three patients had giant cell tumor of bone, one of which accompanied with a secondary aneurysmal bone cyst;9 patients had chondroblastoma and a secondary aneurysmal bone cyst was found in 7 of 9;the other 3 patients were diagnosed with fibrous histiocytoma, hemangioma with a secondary aneurysmal bone cyst and metastatic adenocarcinoma, respectively.Twelve patellar tumors were found at the Enneking stage 2 and 2 at stage 3.There were 7 male and 8 female patients aged from 18 to 66 years old, with an average age of 31.7 years.Among the 15 patellar tumors, 7 occurred in the left side and 8 in the right side.Three patients complained with patellar fractures initially, while the rest came to hospital for the anterior knee pain.Of the total 15 patients, 3 patients underwent patellectomy;10 patients underwent curettage combined with bone graft;the other 2 received curettage combined with bone graft and internal fixation.ResultsOne patient with chondroblastoma and a secondary aneurysmal bone cyst was lost during the follow-up.The rest 14 patients were followed for 6 to 25 months, with 13.9 months on average.One patient who suffered metastatic adenocarcinoma died within 8 months;the rest all had normal knee function with no recurrence or metastases.The Oxford Knee Scores of the 14 patients ranged from 13 to 20, with an average score of 15.6.The post-operative X-ray demonstrated that the 14 patients had varied degree of bone union.ConclusionAs for the patients with pain in the anterior knees, an X-ray should be conducted at an early stage to rule out the patellar tumor.We recommend curettage combined with bone graft for benign bone tumor with Enneking stage 1 or 2 and patellectomy for benign bone tumor with Enneking stage 3, primary malignant bone tumor or metastatic bone tumor.