Balke Maurice, Streitbuerger Arne, Budny Tymoteusz, Henrichs Marcel, Gosheger Georg, Hardes Jendrik
Department of Orthopedic Surgery, University Hospital Muenster, Muenster, Germany.
Acta Orthop. 2009 Oct;80(5):590-6. doi: 10.3109/17453670903350123.
Giant cell tumors (GCTs) of bone rarely affect the pelvis. We report on 20 cases that have been treated at our institution during the last 20 years.
20 patients with histologically benign GCT of the pelvis were included in this study. 9 tumors were primarily located in the iliosacral area, 6 in the acetabular area, and 5 in the ischiopubic area. 8 patients were treated by intralesional curettage and 6 by intralesional resection with additional curettage of the margins. 3 patients with iliacal tumors were treated by wide resection. 2 patients were treated by a combination of external beam irradiation and surgery, and 1 patient solely by irradiation. In addition, 9 patients received selective arterial embolization one day before surgery. Of the 6 patients with acetabular tumors, 1 secondarily received an endoprosthesis and 1 was primarily treated by hip transposition. The patients were followed for a median time of 3 (1-11) years.
1 patient with a pubic tumor developed a local recurrence 1 year after intralesional resection and additional curettage of the margins. The recurrence presented as a small soft tissue mass within the scar tissue of the gluteal muscles and was treated by resection. No secondary sarcoma was detected and none of the patients developed pulmonary metastases or multicentricity. No major complication occurred during surgery.
We conclude that most GCTs of the pelvis can be treated by intralesional procedures. For tumors of the iliac wing, wide resection can be an alternative. Surgical treatment of tumors affecting the acetabular region often results in functional impairment. Pre-surgical selective arterial embolization appears to be a safe procedure that may reduce the risk of local recurrence.
骨巨细胞瘤（GCT）很少累及骨盆。我们报告过去20年在本机构治疗的20例病例。
本研究纳入20例组织学诊断为骨盆良性GCT的患者。9个肿瘤主要位于髂骶区，6个位于髋臼区，5个位于耻骨坐骨区。8例患者接受病灶内刮除术，6例接受病灶内切除并附加边缘刮除术。3例髂骨肿瘤患者接受广泛切除术。2例患者接受外照射与手术联合治疗，1例仅接受照射。此外，9例患者在手术前一天接受选择性动脉栓塞。6例髋臼肿瘤患者中，1例二期接受了假体植入，1例一期接受髋关节置换治疗。对患者进行了中位时间为3（1 - 11）年的随访。
1例耻骨肿瘤患者在病灶内切除并附加边缘刮除术后1年出现局部复发。复发表现为臀肌瘢痕组织内的一个小软组织肿块，经切除治疗。未检测到继发性肉瘤，且无患者发生肺转移或多中心性病变。手术期间未发生重大并发症。
我们得出结论，大多数骨盆GCT可通过病灶内手术治疗。对于髂骨翼肿瘤，广泛切除可作为一种选择。影响髋臼区域肿瘤的手术治疗常导致功能障碍。术前选择性动脉栓塞似乎是一种安全的手术，可降低局部复发风险。
