Lv Chaoliang, Tu Chongqi, Min Li, Duan Hong
Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Orthopedics. 2012 Mar 7;35(3):e397-402. doi: 10.3928/01477447-20120222-17.
Giant cell tumors of bone are aggressive benign tumors. Wide resection is reserved for a small subset of patients with biologically more aggressive, recurrent, and extensive tumors. For patients with giant cell tumors who are young or middle-aged adults with normal life expectancies and high levels of activity, arthrodesis is an option for reconstruction after resection. We retrospectively studied 40 patients (mean age, 33.1 years) with Campanacci grade III giant cell tumors around the knee (12 distal femoral and 28 proximal tibial) that were treated with wide resection and allograft arthrodesis using compression plating between January 1998 and January 2008. At an average follow-up of 4.3 years (range, 2-10 years), no patient had local recurrence, malignant transformation, or pulmonary or distant metastases. The grafts united proximally and distally in 35 (87.5%) patients. Average limb-length shortening was 2 cm (range, 1.5-5 cm). No patient needed a lengthening procedure. Functional outcomes according to the Musculoskeletal Tumor Society measure were successful, with an average score of 26.3 points (range, 22-30 points). Wide resection with allograft arthrodesis of the knee is a treatment option in young, active patients with Campanacci grade III giant cell tumors around the knee. Wide resection and reconstruction with knee allograft arthrodesis for giant cell tumors can achieve excellent control of disease, high fusion rates, acceptable functional results, and low complication rates.
骨巨细胞瘤是侵袭性良性肿瘤。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。对于预期寿命正常且活动水平较高的中青年骨巨细胞瘤患者，关节融合术是切除术后重建的一种选择。我们回顾性研究了1998年1月至2008年1月期间接受广泛切除及同种异体骨移植关节融合术并使用加压钢板固定治疗的40例膝关节周围Campanacci III级骨巨细胞瘤患者（平均年龄33.1岁），其中12例为股骨远端肿瘤，28例为胫骨近端肿瘤。平均随访4.3年（范围2 - 10年），无患者出现局部复发、恶性转化或肺转移及远处转移。35例（87.5%）患者的移植骨远近端均融合。平均肢体短缩2 cm（范围1.5 - 5 cm）。无患者需要进行延长手术。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26.3分（范围22 - 30分）。对于膝关节周围Campanacci III级骨巨细胞瘤的年轻、活跃患者，广泛切除及同种异体骨移植关节融合术是一种治疗选择。对于骨巨细胞瘤采用广泛切除及膝关节同种异体骨移植关节融合术进行重建可实现对疾病的良好控制、高融合率、可接受的功能结果及低并发症发生率。
