Center of Musculoskeletal Surgery, Department of Orthopaedic Surgery, University Medical Center Johannes Gutenberg University Mainz, 55131 Mainz, Germany.
Anticancer Res. 2010 Sep;30(9):3795-9.
Giant cell tumor of bone near the knee joints is a dilemma for the operating surgeon. Curettage and bone grafting have a high recurrence, whereas wide resection has a reduced recurrence rate with the compromise of limb function.
Thirty-eight patients with histologically proven giant cell tumor near the knee joint were treated. All patients were reviewed with regard to the operative method, recurrence rate, postoperative arthritis and functional results of the joint. In cases of cement filling, the radiolucent zone and the sclerotic rim were assessed as possible markers for recurrence.
14 male and 24 female patients were included in this study (mean age 28 years, range 13-56 years). All patients underwent surgery, 21 patients were treated with a bone cement filling and additional osteosynthesis after curettage. Seventeen patients were filled with cancellous bone or curettage alone. In the group with bone cement filling after curettage, the recurrence rate was 23.8%, whereas a recurrence rate of 52.9% was detected in the group with cancellous bone filling or curettage alone. The average time to recurrence was two years (5 months to 6 years). An increase of the radiolucent zone was seen in 80% of all patients with a recurrence.
Cement filling after extensive curettage does not increase the recurrence rate and does not induce osteoarthritis, as long as the continuity of articular cartilage is maintained. Patients with giant cell tumor of bone near the knee joint can be treated satisfactorily with intralesional resection and bone cement packing. The extension of the radiolucent zone after bone cement filling is a reliable indicator for a possible local recurrence.
膝关节附近的骨巨细胞瘤对手术医生来说是一个难题。刮除和植骨有很高的复发率，而广泛切除虽然复发率较低，但会影响肢体功能。
对 38 例经组织学证实的膝关节附近骨巨细胞瘤患者进行治疗。所有患者均接受手术治疗，根据手术方法、复发率、术后关节炎和关节功能结果进行回顾性分析。在骨水泥填充的病例中，评估了透光区和硬化环作为可能的复发标志物。
本研究共纳入 14 例男性和 24 例女性患者（平均年龄 28 岁，范围 13-56 岁）。所有患者均接受手术治疗，21 例患者在刮除后采用骨水泥填充和附加骨合成治疗。17 例患者采用松质骨或单纯刮除治疗。在刮除后骨水泥填充组中，复发率为 23.8%，而在松质骨填充或单纯刮除组中，复发率为 52.9%。平均复发时间为 2 年（5 个月至 6 年）。所有复发患者中有 80%可见透光区增大。
只要关节软骨连续性得以维持，广泛刮除后进行骨水泥填充不会增加复发率，也不会引起骨关节炎。膝关节附近骨巨细胞瘤患者可以通过肿瘤内切除术和骨水泥填充得到满意的治疗。骨水泥填充后透光区的扩大是局部复发的可靠指标。
