Kofránek I, Matĕjovský Z, Frühaufová V, Hedvábný Z, Trnka V
Ortopedická klinika ILF, Fakultní nemocnice Bulovka, Praha.
Acta Chir Orthop Traumatol Cech. 1990 Apr;57(2):151-60.
The classical giant cell tumor represents a problem as the clinical, radiological and histological parameters not always exclude the tendency to local recurrences, rarely also to metastases. Surgical treatment of this tumor is characterized by a relatively high percentage of local recurrences. In the years 1965-1987 patients with 72 giant cell tumors were treated within the Prague Team for Bone Tumors. In 1980 the existing results were revised in 37 patients operated on to that time and the therapeutical scheme was changed by the introduction of new methods mainly the application of bone cement. While in 17 patients we have primarily operated on in the years 1965-1980 recurrence occurred in 36 per cent, in the period 1981-1987 in 32 patients primarily operated on the recurrence amounted to 9.4 per cent, i.e. it occurred in three patients. In these three patients it was the case of excochleation and primary filling by autografts. In 13 cases of the application of bone cement for the filling of the defect after the removal of the tumor there was no recurrence. In the average interval of 1 year since the operation bone cement was substituted by author allografts. In case of an extensive resection of greater part of the joint the application proved right of the massive allografts, fixed by stable osteosynthesis, exclusively in some cases also the application of a special tumorous endoprosthesis in the area of the hip, knee and shoulder.
经典型骨巨细胞瘤是个难题，因为临床、放射学和组织学参数并不总能排除局部复发的倾向，很少情况下也不能排除转移的倾向。该肿瘤的外科治疗特点是局部复发率相对较高。1965年至1987年期间，布拉格骨肿瘤治疗团队对72例骨巨细胞瘤患者进行了治疗。1980年，对当时已接受手术的37例患者的现有结果进行了修订，并通过引入新方法，主要是应用骨水泥，改变了治疗方案。1965年至1980年期间最初接受手术的17例患者中，复发率为36%；1981年至1987年期间最初接受手术的32例患者中，复发率为9.4%，即3例复发。这3例患者均为刮除术并自体骨初次填充。在13例应用骨水泥填充肿瘤切除后缺损的病例中，无复发情况。术后平均1年，作者用异体骨替换了骨水泥。在关节大部分广泛切除的情况下，事实证明在某些病例中应用通过稳定骨固定的大块异体骨是正确的，在髋部、膝部和肩部区域还专门应用了肿瘤型人工关节。
