不同术式治疗四肢长骨骨端骨巨细胞瘤的疗效分析

摘要

目的 分析不同手术方法 治疗四肢长骨骨巨细胞瘤的临床效果.方法 收集我院自1982～2005年有完整随访资料的骨巨细胞瘤共113 例.其中男62 例,女51 例;年龄18～55 岁,平均年龄34.2 岁.Campanicci放射学分级:Ⅰ级30 例,Ⅱ级55 例,Ⅲ级28 例.Jaffe病理分级:1级27 例,2级61 例,3级25 例.其中刮除植骨41 例,骨水泥填充44 例,瘤段切除28 例.结果 获随访15年以上病例28 例,10～15年37 例,5～10年35 例,3～5年13 例,平均随访12.3年.其中植骨组复发8 例,复发率为19.51%;骨水泥填充组复发5 例,复发率为11.36%;瘤骨段切组复发1 例,复发率为3.57%.结论 囊内刮除加灭活术仍是治疗GCT首选方法 ,可根据患者影像学表现、年龄等具体情况选择植骨术或者骨水泥填充术,瘤段切除对于侵袭范围较大、有恶变趋势以及反复复发的病例是一种有效的手术方法 ,但需严格掌握适应证.%Objective To evaluate the clinical results of the giant cell tumors of long bones treated with different surgical treatments.Methods A retrospective review was performed with 113 patients who presented to our hospital between 1982 and 2005 with the giant cell tumors of long bones.They were 62 males and 51 females.The ages ranged from 18 to 55 years and the mean was 34.2 years.Using Campanacci′s staging system:30 cases were classified as grade Ⅰ,55 as grade Ⅱ and 28 as grade Ⅲ.By the Jaffe′s classification,27 patients were in Grade1,61 in Grade2,and 25 in Grade 3.Patients were divided into three groups according to the treatment methods;Group1:(41patients)treated by thorough curettage,alcohol deactivation of tumor and bone transplantation.Group2:(44 patients)treated by thorough curettage,alcohol deactivation of tumor and packing the cavity with bone cement.Group 3:(28 patients)en-bloc resection.Observing curative effect by follow-up visit.Results 28 cases were followed up more than 15 years;37 cases were followed up more than 10 years;35 cases were followed up more than 5 years and 13 cases were followed up more than 3 years;the mean follow-up time was 12.3 years.The rate of local recurrence was 19.51% in Group 1;11.36% in Group 2 and only 3.57% in Group 3.Conclusion Intralesional curettage with adjuvant therapies is the preferred method,according to the imageology、age and other specific condition,we choose bone graft or cement-filled operation.Patients with more extensive,biologically aggressive,and/or recurrent tumours are best treated with en-bloc resection,but need strictly controling indication.