Muramatsu Keiichi, Ihara Koichiro, Taguchi Toshihiko
Department of Orthopedic Surgery, Yamaguchi University School of Medicine, 1-1-1 Minami-Kogushi, Ube, Yamaguchi 755-8505, Japan.
Orthopedics. 2009 Jul;32(7):491. doi: 10.3928/01477447-20090527-08.
Giant cell tumor of bone is a rare and unpredictable lesion. Standard treatment ranges from surgical curettage to wide resection, with reports of varying oncological and functional results. Twenty-three consecutive cases of giant cell tumor of long bones were treated in 10 years. Fifteen men and 8 women had a mean age of 38 years (range, 17-82 years). Average follow-up was 45 months (range, 12-180 months). The most common tumor sites were the proximal tibia (10 cases), distal femur (8), and distal radius (3). All patients remained free of recurrence at the time of final follow-up. Functional outcomes as evaluated by the Musculoskeletal Tumor Society measure were successful, with an average score of 26.6 points (range, 22-30 points). To avoid local recurrence around the knee joint, we recommend radical intralesional curettage with a high-speed drill burr, adjunctive therapy with cryosurgery, and filling with polymethylmethacrylate. Primary total knee arthroplasty is acceptable for older patients. For giant cell tumor of the upper limb or for young patients, biological reconstruction should be applied.
骨巨细胞瘤是一种罕见且难以预测的病变。标准治疗方法从手术刮除到广泛切除不等，不同的肿瘤学和功能结果报道各异。10年间连续治疗了23例长骨骨巨细胞瘤患者。其中15名男性和8名女性，平均年龄38岁（范围17 - 82岁）。平均随访时间为45个月（范围12 - 180个月）。最常见的肿瘤部位是胫骨近端（10例）、股骨远端（8例）和桡骨远端（3例）。在最后一次随访时，所有患者均无复发。根据肌肉骨骼肿瘤学会的评估标准，功能结果良好，平均评分为26.6分（范围22 - 30分）。为避免膝关节周围局部复发，我们建议使用高速磨钻进行根治性病灶内刮除，辅助冷冻治疗，并填充聚甲基丙烯酸甲酯。对于老年患者，一期全膝关节置换术是可以接受的。对于上肢骨巨细胞瘤或年轻患者，应采用生物重建。
