病理性骨折的巨细胞瘤：我们应该刮除还是切除？
Giant cell tumor with pathologic fracture: should we curette or resect?
机构信息
Department of Orthopaedic Surgery, Leiden University Medical Center, Postzone J11-R70, PO Box 9600, 2300 RC Leiden, The Netherlands.
出版信息
Clin Orthop Relat Res. 2013 Mar;471(3):820-9. doi: 10.1007/s11999-012-2546-6.
BACKGROUND
Approximately one in five patients with giant cell tumor of bone presents with a pathologic fracture. However, recurrence rates after resection or curettage differ substantially in the literature and it is unclear when curettage is reasonable after fracture.
QUESTIONS/PURPOSES: We therefore determined: (1) local recurrence rates after curettage with adjuvants or en bloc resection; (2) complication rates after both surgical techniques and whether fracture healing occurred after curettage with adjuvants; and (3) function after both treatment modalities for giant cell tumor of bone with a pathologic fracture.
METHODS
We retrospectively reviewed 48 patients with fracture from among 422 patients treated between 1981 and 2009. The primary treatment was resection in 25 and curettage with adjuvants in 23 patients. Minimum followup was 27 months (mean, 101 months; range, 27-293 months).
RESULTS
Recurrence rate was higher after curettage with adjuvants when compared with resection (30% versus 0%). Recurrence risk appears higher with soft tissue extension. The complication rate was lower after curettage with adjuvants when compared with resection (4% versus 16%) and included aseptic loosening of prosthesis, allograft failure, and pseudoarthrosis. Tumor and fracture characteristics did not increase complication risk. Fracture healing occurred in 24 of 25 patients. Mean Musculoskeletal Tumor Society score was higher after curettage with adjuvants (mean, 28; range, 23-30; n = 18) when compared with resection (mean, 25; range, 13-30; n = 25).
CONCLUSIONS
Our observations suggest curettage with adjuvants is a reasonable option for giant cell tumor of bone with pathologic fractures. Resection should be considered with soft tissue extension, fracture through a local recurrence, or when structural integrity cannot be regained after reconstruction.
LEVEL OF EVIDENCE
Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
背景
大约五分之一的骨巨细胞瘤患者会出现病理性骨折。然而，文献中切除或刮除后的复发率差异很大，目前尚不清楚在骨折后何时进行刮除是合理的。
问题/目的：因此，我们确定：（1）辅助刮除或整块切除后的局部复发率；（2）两种手术技术的并发症发生率，以及辅助刮除后是否发生骨折愈合；（3）病理性骨折骨巨细胞瘤的两种治疗方式后的功能。
方法
我们回顾性地研究了 1981 年至 2009 年间治疗的 422 例患者中的 48 例骨折患者。主要治疗方法是 25 例切除和 23 例辅助刮除。随访时间至少为 27 个月（平均 101 个月；范围 27-293 个月）。
结果
与切除相比，辅助刮除后的复发率更高（30%比 0%）。软组织延伸时复发风险似乎更高。辅助刮除后的并发症发生率低于切除（4%比 16%），包括假体无菌性松动、同种异体骨失败和假关节。肿瘤和骨折特征不会增加并发症风险。25 例患者中有 24 例骨折愈合。与切除相比，辅助刮除后的肌肉骨骼肿瘤协会评分更高（平均 28 分；范围 23-30 分；n=18），切除后的评分更低（平均 25 分；范围 13-30 分；n=25）。
结论
我们的观察结果表明，对于有病理骨折的骨巨细胞瘤，辅助刮除是一种合理的选择。当存在软组织延伸、骨折穿过局部复发或在重建后无法恢复结构完整性时，应考虑切除。
证据水平
III 级，治疗研究。有关证据水平的完整描述，请参见作者指南。
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