Malawer M M, Bickels J, Meller I, Buch R G, Henshaw R M, Kollender Y
Washington Cancer Institute, Washington Hospital Center, Washington, DC 20010, USA.
Clin Orthop Relat Res. 1999 Feb(359):176-88. doi: 10.1097/00003086-199902000-00019.
Between 1983 and 1993, 102 patients with giant cell tumor of bone were treated at three institutions. Sixteen patients (15.9%) presented with already having had local recurrence. All patients were treated with thorough curettage of the tumor, burr drilling of the tumor inner walls, and cryotherapy by direct pour technique using liquid nitrogen. The average followup was 6.5 years (range, 4-15 years). The rate of local recurrence in the 86 patients treated primarily with cryosurgery was 2.3% (two patients), and the overall recurrence rate was 7.9% (eight patients). Six of these patients were cured by cryosurgery and two underwent resection. Overall, 100 of 102 patients were cured with cryosurgery. Complications associated with cryosurgery included six (5.9%) pathologic fractures, three (2.9%) cases of partial skin necrosis, and two (1.9%) significant degenerative changes. Overall function was good to excellent in 94 patients (92.2%), moderate in seven patients (6.9%), and poor in one patient (0.9%). Cryosurgery has the advantages of joint preservation, excellent functional outcome, and low recurrence rate when compared with other joint preservation procedures. For these reasons, it is recommended as an adjuvant to curettage for most giant cell tumors of bone.
1983年至1993年间，三家机构共治疗了102例骨巨细胞瘤患者。16例患者（15.9%）就诊时已有局部复发。所有患者均接受了肿瘤的彻底刮除、肿瘤内壁的磨钻处理以及采用液氮直接灌注技术的冷冻治疗。平均随访时间为6.5年（范围4至15年）。86例主要接受冷冻手术治疗的患者局部复发率为2.3%（2例患者），总体复发率为7.9%（8例患者）。其中6例患者通过冷冻手术治愈，2例接受了切除术。总体而言，102例患者中有100例通过冷冻手术治愈。与冷冻手术相关的并发症包括6例（5.9%）病理性骨折、3例（2.9%）局部皮肤坏死以及2例（1.9%）明显的退行性改变。94例患者（92.2%）的总体功能良好至优秀，7例患者（6.9%）为中度，1例患者（0.9%）为差。与其他保关节手术相比，冷冻手术具有保关节、功能预后良好以及复发率低的优点。基于这些原因，对于大多数骨巨细胞瘤，推荐将其作为刮除术的辅助治疗方法。
