Kapoor Sudhir K, Tiwari Akshay
Department of Orthopaedics, Lady Hardinge Medical College and Associated Hospitals, New Delhi - 110 001, India.
Indian J Orthop. 2007 Apr;41(2):124-8. doi: 10.4103/0019-5413.32043.
Giant cell tumors (GCTs) of bone are aggressive benign tumors. Wide resection is reserved for a small subset of patients with biologically more aggressive, recurrent and extensive tumors. As the patients affected with GCT are young or middle-aged adults with a normal life expectancy, arthrodesis is an attractive option for reconstruction in these patients.
Thirty-six patients of mean age 33.1 years with Campanacci Grade III giant cell tumors around the knee (20 distal femoral and 16 proximal tibial) were treated with wide resection and arthrodesis from January 1996 through January 2006. Arthrodesis was performed using plating with free fibular graft (n = 18), IM nail with free fibular graft (n = 8) and IM nail combined with ring fixator using bone transport (n = 10).
Fusion after the first surgery was achieved in 77.7%, 75% and 90% of the patients in the three groups respectively. Local recurrence was seen in two patients and repeat surgery for nonunion/ graft fracture had to be done in four patients and two patients in the plating and nailing groups respectively.
Wide resection and arthrodesis in aggressive GCTs around the knee is a good treatment option. IM nail combined with a ring fixator seems to be a good method of arthrodesis with high fusion rates, least shortening and early rehabilitation.
骨巨细胞瘤（GCT）是侵袭性良性肿瘤。广泛切除仅适用于一小部分生物学行为更具侵袭性、复发性和广泛性肿瘤的患者。由于患有GCT的患者为年轻或中年成年人，预期寿命正常，关节融合术是这些患者重建的一个有吸引力的选择。
1996年1月至2006年1月，对36例平均年龄33.1岁、膝关节周围Campanacci III级骨巨细胞瘤患者（20例股骨远端和16例胫骨近端）进行了广泛切除和关节融合术。关节融合术采用带游离腓骨移植的钢板固定（n = 18）、带游离腓骨移植的髓内钉固定（n = 8）以及髓内钉联合环形固定器骨搬运技术（n = 10）。
三组患者首次手术后的融合率分别为77.7%、75%和90%。2例患者出现局部复发，钢板固定组和髓内钉固定组分别有4例和2例患者因骨不连/移植骨骨折需要再次手术。
膝关节周围侵袭性GCT的广泛切除和关节融合术是一种良好的治疗选择。髓内钉联合环形固定器似乎是一种融合率高、缩短最少且康复早的良好关节融合方法。
