Deheshi Benjamin M, Jaffer Shabana N, Griffin Anthony M, Ferguson Peter C, Bell Robert S, Wunder Jay S
University Musculoskeletal Oncology Unit, Mount Sinai Hospital, Toronto, Ontario, Canada.
Clin Orthop Relat Res. 2007 Jun;459:96-104. doi: 10.1097/BLO.0b013e31805d85e4.
Pathologic fracture through giant cell tumor is thought to be associated with higher rates of recurrence and poor functional outcome. We compared patients with and without pathologic fracture through giant cell tumor of weightbearing long bones. We retrospectively reviewed 139 patients with giant cell tumor of weightbearing long bones with (n = 43) and without (n = 96) pathologic fracture at presentation; the two groups had similar demographics. Joint salvage was successful in 84% of the fracture group and 96% of the nonfracture group. Five-year recurrence-free survival rates were comparable between the two groups (82.6% [95% confidence interval, 69.1-95.9%] in the fracture group and 77.9% [95% confidence interval, 67.7-88.1%] in the non-fracture group). There was a trend toward lower 5-year metastatic-free survival in the fracture group (94.7% [95% confidence interval, 87.3-100%]) than in the nonfracture group (97.3% [95% confidence interval, 93.5-100%]). Functional outcome was good and similar in the two groups. Arthrofibrosis was more common in the group with pathologic fracture. Joint salvage for patients with pathologic fractures through giant cell tumor of weightbearing bones is a reasonable option with functional outcomes and recurrence rates comparable to those of patients without fracture.
经骨巨细胞瘤发生的病理性骨折被认为与更高的复发率和不良功能结局相关。我们比较了负重长骨骨巨细胞瘤患者中发生和未发生病理性骨折的情况。我们回顾性分析了139例负重长骨骨巨细胞瘤患者，其中43例初诊时伴有病理性骨折，96例初诊时无病理性骨折；两组患者的人口统计学特征相似。骨折组84%的患者保关节成功，非骨折组为96%。两组的5年无复发生存率相当（骨折组为82.6%[95%置信区间，69.1 - 95.9%]，非骨折组为77.9%[95%置信区间，67.7 - 88.1%]）。骨折组的5年无转移生存率有低于非骨折组的趋势（骨折组为94.7%[95%置信区间，87.3 - 100%]，非骨折组为97.3%[95%置信区间，93.5 - 100%]）。两组的功能结局良好且相似。关节纤维化在病理性骨折组更为常见。对于负重骨骨巨细胞瘤病理性骨折患者，保关节是一种合理的选择，其功能结局和复发率与无骨折患者相当。
