复发性骨巨细胞瘤的手术治疗
Surgical Treatment of Recurrent Giant Cell Tumors of Bone
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摘要: 目的 探讨复发性骨巨细胞瘤的手术治疗选择。方法 回顾我院近3年收治的复发性骨巨细胞瘤23例,分析术后复发情况,评价关节功能。结果 本组病例中,7例行再次病灶刮除植骨,13例行瘤段切除,3例行截肢。平均随访26.5个月,21例无复发,1例复发伴肺转移,1例死亡。瘤段切除病例中,10例行人工关节置换,2例行异体骨移植。对病灶刮除组、关节置换组和异体骨移植组进行Ennek-ing功能评分,分别为29.8、25.2和22分。病灶刮除组和异体骨移植组差异有统计学意义(P〈0.05)。结论 复发性骨巨细胞瘤首选病灶刮除。如存在病灶刮除反指征,则膝关节周围选择瘤段切除人工关节置换,腕关节周围选择带关节异体骨移植或同时合并关节融合。骨盆部位复发病例首选瘤段切除。Abstract: Objective To evaluate different choices of the surgical approach to recurrent giant cell tumors of bone. Methods In the recent 3 years, 23 cases of recurrent giant cell tumor were overviewed ret ropectively. The recurrence rate and the function of adjiacent joint were analyzed. Results In this series, 7 cases had curettage, 13 cases had wide resection and 3 cases had amputation. All patients had been followed up for a meantime of 26. 5 months. There were only 1 case of recurrence with lung metatasis and 1 case of death. In the wide resection group, 10 cases were reconst ruced with prosthetic replacement, and 2 cases with allograft . The enneking functional score of curettage group, prosthetic replacement group and allograf t group were 29. 8, 25. 2 and 22 respectively. There had statistically difference between curettage group and allograf t group ( P < 0. 05) . Conclusion In recurrent giant cell tumors of bone, curet tage method was recommended firstly. If there had any anti-index of curretage, lesions around the knee should be treated with wide resection and prosthetic replacement, and lesions around the wrist should be t reated with wide resection and allograft with or without arthrodesis. Lesions located in the pelvis and sacrum should be treated with wide resection.