Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, Hunan, 410008, PR China.
Clin Orthop Relat Res. 2012 Oct;470(10):2886-94. doi: 10.1007/s11999-012-2464-7. Epub 2012 Jul 7.
Intralesional excision and en bloc resection are used to treat giant cell tumors (GCTs) of the distal radius. However, it is unclear whether one provides lower rates of recurrences and fewer complications, and whether the use of polymethylmethacrylate (PMMA) after curettage reduces the risk of recurrence.
QUESTIONS/PURPOSES: We examined whether curettage was associated with lower rates of recurrence and fewer major complications compared with en bloc excision, and whether PMMA resulted in lower rates of recurrence compared with a bone graft.
We systematically searched the literature using the criteria, "giant cell tumor" AND "curettage" OR "intralesional excision" OR "resection". Six relevant articles were identified that reported data for 80 curettage cases (PMMA, n = 49; bone graft, n = 26; no PMMA or bone grafts, n = 5) and 59 involving en bloc excision. A meta-analysis was performed using these data.
Overall, patients in the intralesional excision group had a higher recurrence rate (relative risk [RR], 2.80; 95% CI, 1.17-6.71), especially for Campanacci grade 3 GCTs (RR, 4.90; 95% CI, 1.36-17.66), yet fewer major complications (RR, 0.21; 95% CI, 0.09-0.54) than the en bloc resection group. The use of PMMA versus bone graft did not affect the recurrence rate (RR, 0.98; 95% CI, 0.44-2.17).
Based on data obtained from the limited number of studies available, intralesional excision appears to be more appropriate for the treatment of local lesions (e.g., grades 1 and 2) than grade 3 GCTs of the distal radius. Moreover, PMMA was not additionally effective as an adjuvant.
Level III, therapeutic study (systematic review). See Guidelines for Authors for a complete description of levels of evidence.
局部切除术和整块切除术均被用于治疗桡骨远端的骨巨细胞瘤（GCT）。但是，目前仍不清楚哪种方法能降低复发率和减少并发症，以及在刮除后使用聚甲基丙烯酸甲酯（PMMA）是否能降低复发风险。
问题/目的：我们研究了刮除术与整块切除术相比，是否能降低复发率和减少主要并发症，以及 PMMA 是否比骨移植更能降低复发率。
我们使用“giant cell tumor（巨细胞瘤）”和“curettage（刮除术）”或“intralesional excision（局部切除术）”或“resection（切除术）”等关键词，系统地检索了文献。共确定了 6 篇相关文献，这些文献共报道了 80 例刮除术病例（PMMA 组 49 例，骨移植组 26 例，未使用 PMMA 或骨移植组 5 例）和 59 例整块切除术病例。我们使用这些数据进行了荟萃分析。
总体而言，局部切除术组患者的复发率更高（相对风险 [RR]，2.80；95%置信区间 [CI]，1.17-6.71），尤其是 Campanacci 分级 3 的 GCT 患者（RR，4.90；95% CI，1.36-17.66），但主要并发症较少（RR，0.21；95% CI，0.09-0.54）。与整块切除术组相比，使用 PMMA 与骨移植对复发率无影响（RR，0.98；95% CI，0.44-2.17）。
基于现有有限数量的研究数据，局部切除术似乎更适合治疗局部病变（例如，1 级和 2 级），而不适合治疗桡骨远端 3 级 GCT。此外，PMMA 作为辅助手段并无额外效果。
III 级，治疗性研究（系统评价）。欲知完整的证据等级说明，请参见作者指南。
