Division of Orthopaedic Surgery, McGill University, 1650 Cedar Avenue, Montreal, Quebec, H3G 1A4, Canada.
Clin Orthop Relat Res. 2013 Aug;471(8):2668-74. doi: 10.1007/s11999-013-2965-z. Epub 2013 Apr 9.
The distal tibia is an unusual location for a giant cell tumor (GCT). Treatment choices are unclear because of their rarity, the anatomy of the ankle, and difficulties associated with reconstruction.
QUESTIONS/PURPOSES: We assessed: (1) the treatment modalities used by participating Canadian bone tumor centers for distal tibia GCTs; (2) the incidence of local recurrence and their management; and (3) patients' function after treatment.
A prospective tumor database served to identify all 31 patients with primarily treated distal tibia GCTs between 1991 and 2010. We extracted patients and tumor characteristics, treatment modalities for initial and recurrent tumors, and the Musculoskeletal Tumor Society (MSTS) and Toronto Extremity Salvage (TESS) scores. The median followup was 58 months (range, 24-192 months).
Extended curettage was the only modality of treatment for all patients including all subsequent local recurrences. Nine had local recurrence, three of which had a second local recurrence; one had a third recurrence. Ultimately all patients were in remission at last followup. The local recurrence rate was 29% and appeared higher compared with recent series of all anatomic sites. The mean final MSTS and TESS scores were 91% (range, 71%-100%) and 88% (range, 35%-100%), respectively.
Extended curettage was the unique modality of surgical treatment for all tumors. We found the incidence of local recurrence higher than that reported for other locations but recurrences were manageable with repeated curettage. Complications and function appeared better than those reported for series of ankle fusion or reconstruction for bone tumors.
胫骨远端是巨细胞瘤（GCT）的罕见部位。由于其罕见性、踝关节解剖结构以及重建相关的困难，治疗选择尚不明确。
问题/目的：我们评估了：（1）参与加拿大骨肿瘤中心治疗胫骨远端 GCT 的治疗方式；（2）局部复发的发生率及其处理；（3）治疗后患者的功能。
前瞻性肿瘤数据库用于确定 1991 年至 2010 年间所有 31 例经初次治疗的胫骨远端 GCT 患者。我们提取了患者和肿瘤特征、初始和复发性肿瘤的治疗方式，以及肌肉骨骼肿瘤学会（MSTS）和多伦多肢体挽救（TESS）评分。中位随访时间为 58 个月（范围，24-192 个月）。
所有患者均采用广泛刮除术治疗，包括所有后续的局部复发。9 例出现局部复发，其中 3 例出现第二次局部复发，1 例出现第三次复发。最终所有患者在末次随访时均处于缓解状态。局部复发率为 29%，与近期所有解剖部位的系列报道相比似乎更高。最终的平均 MSTS 和 TESS 评分分别为 91%（范围，71%-100%）和 88%（范围，35%-100%）。
广泛刮除术是所有肿瘤的唯一手术治疗方式。我们发现局部复发的发生率高于其他部位的报道，但通过反复刮除可对复发进行有效管理。并发症和功能似乎优于踝关节融合或重建的系列报道。
