Harness Neil G, Mankin Henry J
Orthopaedic Service, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
J Hand Surg Am. 2004 Mar;29(2):188-93. doi: 10.1016/j.jhsa.2003.11.003.
Many authorities express concern that giant-cell tumors of the distal forearm are more frequently recurrent and difficult to treat chiefly because of the proximity to the carpus and the resultant diminished range of motion in the hand and forearm. We have studied the results from our institution for 49 patients with giant-cell tumors of the distal forearm treated from 2 to 28 years (mean, 14 +/- 7 years) and compared the results for different methods of treatment.
Through the computer database 49 patients with giant-cell tumors of the distal forearm (46 of the radius, 3 of the ulna) were identified. By using material from patient visits, chart review, and when necessary telephone interviews it was possible to gather demographic and outcome data for the 49 patients. For the radial lesions, 15 of the patients had a marginal resection of the distal radius along with the periosteum and ligamentous structures and implantation of cadaveric allografts. Twenty-six patients had intralesional curettage and insertion of polymethylmethacrylate (PMMA) and 5 had curettage and autograft insertion. The 3 patients with ulnar lesions were treated with Darrach resections.
There were no deaths, infections, metastases, or amputations. In addition to the 49 original surgeries, the patients required 41 additional surgical procedures, 17 of which were for recurrent disease. The greatest numbers of recurrences were in the patients who underwent curettage with autograft or PMMA implantation. Only 2 recurrences were in patients who had a marginal resection and implantation of cadaveric allografts. The overall results for the patients showed that many had mostly minor complaints referable to function or pain and that only 18 of the 49 patients were asymptomatic.
Although the patients with distal forearm giant-cell tumors have had a difficult course in terms of local recurrence and subsequent surgeries required for treatment failures, the ultimate outcomes for both allograft transplantation and curettage and insertion of PMMA are satisfactory. The patients with complete distal radial allografts had a better record for prevention of recurrence than the patients treated with curettage and PMMA insertion but the percentages of currently asymptomatic patients are approximately the same for both series (40% [6/15], 35% [9/26]). These data support the concept that marginal resection and complete distal radial allograft implantation should be used for patients with tumors that have destroyed much of the bone and have extensive soft tissue components and that curettage and PMMA insertion should be reserved for patients where the structural alteration of the bone is minimal.
许多权威人士担心，前臂远端的骨巨细胞瘤更容易复发且难以治疗，主要原因是其靠近腕关节，导致手部和前臂的活动范围减小。我们研究了本机构对49例前臂远端骨巨细胞瘤患者的治疗结果，这些患者的治疗时间为2至28年（平均14±7年），并比较了不同治疗方法的结果。
通过计算机数据库识别出49例前臂远端骨巨细胞瘤患者（46例位于桡骨，3例位于尺骨）。利用患者就诊资料、病历回顾以及必要时的电话访谈，收集了这49例患者的人口统计学和治疗结果数据。对于桡骨病变，15例患者进行了桡骨远端边缘切除术，包括骨膜和韧带结构，并植入尸体同种异体骨。26例患者进行了病灶内刮除并植入聚甲基丙烯酸甲酯（PMMA），5例患者进行了刮除并植入自体骨。3例尺骨病变患者接受了Darrach切除术。
无死亡、感染、转移或截肢病例。除了最初的49次手术外，患者还需要进行41次额外的手术，其中17次是针对复发病例。复发次数最多的是接受自体骨或PMMA植入刮除术的患者。接受边缘切除并植入尸体同种异体骨的患者中只有2例复发。患者的总体结果显示，许多患者主要有与功能或疼痛相关的轻微不适，49例患者中只有18例无症状。
尽管前臂远端骨巨细胞瘤患者在局部复发和治疗失败所需的后续手术方面经历了艰难的过程，但同种异体骨移植以及刮除并植入PMMA的最终结果均令人满意。接受桡骨远端全同种异体骨移植的患者在预防复发方面的记录优于接受刮除并植入PMMA治疗的患者，但两个系列中目前无症状患者的百分比大致相同（40%[6/15]，35%[9/26]）。这些数据支持这样的观点，即对于骨已被大量破坏且有广泛软组织成分的肿瘤患者，应采用边缘切除和桡骨远端全同种异体骨植入，而刮除并植入PMMA应保留给骨结构改变最小的患者。
