Suzuki Yoshitaka, Nishida Yoshihiro, Yamada Yoshihisa, Tsukushi Satoshi, Sugiura Hideshi, Nakashima Hiroatsu, Ishiguro Naoki
Department of Orthopedic Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan.
Knee. 2007 Oct;14(5):369-74. doi: 10.1016/j.knee.2007.05.008. Epub 2007 Jun 29.
Giant cell tumor of bone occasionally results in secondary osteoarthritic changes in adjacent joints. The purpose of this study was to determine the factors associated with the development of degenerative arthritis in surgically treated patients with giant cell tumor of the distal femur or proximal tibia and the effect of residual subchondral bone thickness on the location of recurrent giant cell tumor. We retrospectively studied 30 patients with giant cell tumor of bone arising around the knee joint treated with intralesional curettage, high-speed burring, and electrocauterization, followed by filling with polymethylmethacrylate or autogenous bone graft. There was no significant difference in factors of age, gender, tumor location, residual thickness of subchondral bone, or Campanacci grade correlated with the recurrence. Of the 10 recurrence cases, seven recurred on the articular side, and three on the contra-articular side of the primary lesion. Less than 5 mm of residual thickness of subchondral bone was correlated with recurrence on the articular side (p=0.038). There were 10 cases (33.3%), in which secondary degenerative arthritic change developed or progressed. Re-operation for local recurrence or post-operative fractures was a significant factor correlated with the progression of secondary osteoarthritis (p=0.010). Less residual thickness of subchondral bone tended to be associated with secondary osteoarthritis (p=0.068). Other factors were not correlated significantly with osteoarthritic change. These data support the contention that the residual thickness of subchondral bone could be a factor predicting the location of recurrence, and operative procedure to avoid re-operation might be critical to preserve knee function.
骨巨细胞瘤偶尔会导致相邻关节出现继发性骨关节炎改变。本研究的目的是确定在接受手术治疗的股骨远端或胫骨近端骨巨细胞瘤患者中，与退行性关节炎发生相关的因素，以及残余软骨下骨厚度对复发性骨巨细胞瘤位置的影响。我们回顾性研究了30例膝关节周围骨巨细胞瘤患者，这些患者接受了病灶内刮除、高速磨钻和电灼治疗，随后用聚甲基丙烯酸甲酯或自体骨移植填充。年龄、性别、肿瘤位置、软骨下骨残余厚度或坎帕纳奇分级等因素与复发之间无显著差异。在10例复发病例中，7例在关节侧复发，3例在原发灶的对关节侧复发。软骨下骨残余厚度小于5mm与关节侧复发相关（p = 0.038）。有10例（33.3%）出现继发性退行性骨关节炎改变或病情进展。因局部复发或术后骨折进行再次手术是与继发性骨关节炎进展相关的重要因素（p = 0.010）。软骨下骨残余厚度较小往往与继发性骨关节炎相关（p = 0.068）。其他因素与骨关节炎改变无显著相关性。这些数据支持以下观点，即软骨下骨残余厚度可能是预测复发位置的一个因素，避免再次手术的手术操作可能对保留膝关节功能至关重要。
