Yang Zheng-ming, Tao Hui-min, Yang Di-sheng, Ye Zhao-ming, Li Wei-xu
Department of Orthopaedics, the Second Affiliated Hospital, Institute of Orthopaedic Research, Medical College Zhejiang University, Hangzhou 310009, China.
Zhonghua Wai Ke Za Zhi. 2006 Dec 15;44(24):1693-8.
To retrospectively study and analyze the methods of the surgery management for giant cell tumor close to the knee.
A retrospective analysis was performed in 121 patients who underwent surgical treatment for giant cell tumor close to the knee between 1978 and 1997. There were 71 cases had been managed with an intralesional procedure of the tumor (curettage, freezing with liquid nitrogen and autograft or allograft, Group 1), 50 cases with a semi-arthroplasty using allograft after en bloc resection (Group 2). According to the relation of the clinical signs and symptoms, tumor character, operative method and local recurrence, limp function, complication were evaluated. Based on the figure of tumor lesion on CT, a new formulation of treatment was given: (1) I diameter of tumor <or= 1/2, choice of an intralesional procedure; (2) II 1/2 approximately 3/4, an intralesional procedure additional inter fixed; (3) III > 3/4, en bloc resection and reconstruction. The prospectively collected records of 65 cases of patients, 45 cases with curettage, heat cauterization with electrocautery and phenol, autograft and cement (Group 1), 20 cases with arthroplasty using prosthetic (Group 2), who had a giant-cell tumor closed knee, were reviewed to determine feasibility of the new formulation of treatment.
The first duration, the rate of the local recurrence between 2 groups showed no statistical difference. There were less complication rate and better limp function after using two different surgical treatment. The second duration, there were no statistical difference with the rate of the local recurrence, complication, and limp function. The number of patients who managed with en bloc resection and reconstruction decreased.
The choice strategy of surgical treatment for giant cell tumor close to the knee should be based on the figure of tumor lesion on CT. It gives a new formulation of treatment to choice of an intralesional procedure and en bloc resection. An effective intralesional procedure should be the method of the first choice.
回顾性研究和分析膝关节周围骨巨细胞瘤的手术治疗方法。
对1978年至1997年间接受手术治疗的121例膝关节周围骨巨细胞瘤患者进行回顾性分析。其中71例行肿瘤内手术（刮除、液氮冷冻及自体或异体骨移植，第1组），50例行整块切除后同种异体半关节置换术（第2组）。根据临床症状体征、肿瘤特点、手术方式及局部复发情况，对肢体功能、并发症进行评估。依据CT上肿瘤病变形态，给出新的治疗方案：（1）肿瘤直径≤1/2，选择肿瘤内手术；（2）肿瘤直径约1/2至3/4，肿瘤内手术加内固定；（3）肿瘤直径＞3/4，整块切除并重建。前瞻性收集65例膝关节周围骨巨细胞瘤患者的资料，其中45例行刮除、电灼和苯酚热灼、自体骨移植及骨水泥填充（第1组），20例行人工关节置换术（第2组），以确定新治疗方案的可行性。
首次随访时，两组局部复发率无统计学差异。两种不同手术治疗后并发症发生率较低，肢体功能较好。再次随访时，局部复发率、并发症及肢体功能无统计学差异。整块切除并重建的患者数量减少。
膝关节周围骨巨细胞瘤的手术治疗选择策略应基于CT上的肿瘤病变形态。它为肿瘤内手术和整块切除的选择提供了新的治疗方案。有效的肿瘤内手术应作为首选方法。
