Balke Maurice, Schremper Laura, Gebert Carsten, Ahrens Helmut, Streitbuerger Arne, Koehler Gabriele, Hardes Jendrik, Gosheger Georg
Department of Orthopedic Surgery, University of Muenster, Muenster, Germany.
J Cancer Res Clin Oncol. 2008 Sep;134(9):969-78. doi: 10.1007/s00432-008-0370-x. Epub 2008 Mar 6.
Two hundred and fourteen patients with benign giant cell tumor of bone (GCTB), treated from 1980 to 2007 at the Department of Orthopedics of the University of Muenster (Germany), were analyzed in a retrospective study.
The mean age was 33.3 years with a female-to-male ratio of 1.2 : 1. The mean follow up was 59.8 months. The recurrence rate of patients who received first treatment at our institution was 16.6%. The most common primary treatment was curettage (188 patients) usually followed by adjuvant local therapy. The effects of bone cement (PMMA), burring and hydrogen peroxide (H(2)O(2)) were statistically analyzed and the influence of a subchondral bone graft on the recurrence rate was evaluated.
PMMA alone (n = 52) reduces the likelihood of recurrence by the factor 8.2, additional high-speed burring (n = 39) by the factor 3.9 (compared to PMMA only). H(2)O(2) (n = 42) seems to have an additional effect comparable to that of phenol although it did not reach statistical significance.
The combination of all adjuncts (PMMA, burring, H(2)O(2) - n = 42) reduces the likelihood of recurrence by the factor 28.2 compared to curettage only and therefore should be recommended as a standard treatment. If the tumor reaches close to the articulating surface a subchondral bone graft (n = 42) can be performed without risking a higher recurrence rate. We add seven cases of pulmonary metastases and two cases of multicentricity to the literature. Bisphosphonates and interferon alpha may have a beneficial effect.
对1980年至2007年在德国明斯特大学骨科接受治疗的214例骨巨细胞瘤（GCTB）患者进行了一项回顾性研究。
平均年龄为33.3岁，女性与男性比例为1.2∶1。平均随访时间为59.8个月。在我们机构接受首次治疗的患者复发率为16.6%。最常见的主要治疗方法是刮除术（188例患者），通常随后进行辅助局部治疗。对骨水泥（PMMA）、高速磨钻和过氧化氢（H₂O₂）的效果进行了统计学分析，并评估了软骨下骨移植对复发率的影响。
单独使用PMMA（n = 52）可使复发可能性降低8.2倍，额外进行高速磨钻（n = 39）可使复发可能性降低3.9倍（与仅使用PMMA相比）。H₂O₂（n = 42）似乎具有与苯酚相当的额外效果，尽管未达到统计学显著性。
与仅进行刮除术相比，所有辅助治疗方法联合使用（PMMA、高速磨钻、H₂O₂ - n = 42）可使复发可能性降低28.2倍，因此应推荐作为标准治疗方法。如果肿瘤接近关节面，可进行软骨下骨移植（n = 42）而不会增加更高的复发风险。我们在文献中增加了7例肺转移和2例多中心性病例。双膦酸盐和α干扰素可能具有有益作用。
