Centro Hospitalar do Porto - Hospital Santo Antonio, Department of Orthopaedic Surgery, Largo Prof Abel Salazar, 4099-001 Porto, Portugal.
Bone Joint J. 2013 Jun;95-B(6):838-45. doi: 10.1302/0301-620X.95B6.30876.
Giant cell tumours (GCTs) of the small bones of the hands and feet are rare. Small case series have been published but there is no consensus about ideal treatment. We performed a systematic review, initially screening 775 titles, and included 12 papers comprising 91 patients with GCT of the small bones of the hands and feet. The rate of recurrence across these publications was found to be 72% (18 of 25) in those treated with isolated curettage, 13% (2 of 15) in those treated with curettage plus adjuvants, 15% (6 of 41) in those treated by resection and 10% (1 of 10) in those treated by amputation. We then retrospectively analysed 30 patients treated for GCT of the small bones of the hands and feet between 1987 and 2010 in five specialised centres. The primary treatment was curettage in six, curettage with adjuvants (phenol or liquid nitrogen with or without polymethylmethacrylate (PMMA)) in 18 and resection in six. We evaluated the rate of complications and recurrence as well as the factors that influenced their functional outcome. At a mean follow-up of 7.9 years (2 to 26) the rate of recurrence was 50% (n = 3) in those patients treated with isolated curettage, 22% (n = 4) in those treated with curettage plus adjuvants and 17% (n = 1) in those treated with resection (p = 0.404). The only complication was pain in one patient, which resolved after surgical removal of remnants of PMMA. We could not identify any individual factors associated with a higher rate of complications or recurrence. The mean post-operative Musculoskeletal Tumor Society scores were slightly higher after intra-lesional treatment including isolated curettage and curettage plus adjuvants (29 (20 to 30)) compared with resection (25 (15 to 30)) (p = 0.091). Repeated curettage with adjuvants eventually resulted in the cure for all patients and is therefore a reasonable treatment for both primary and recurrent GCT of the small bones of the hands and feet.
手部和足部小骨的巨细胞瘤（GCT）很少见。已经发表了一些小病例系列，但对于理想的治疗方法尚无共识。我们进行了系统评价，最初筛选了 775 个标题，并纳入了 12 篇论文，其中包括 91 例手部和足部小骨 GCT 患者。在这些出版物中，单独刮除治疗的复发率为 72%（25 例中的 18 例），刮除加辅助治疗的复发率为 13%（15 例中的 2 例），切除的复发率为 15%（41 例中的 6 例），截肢的复发率为 10%（10 例中的 1 例）。然后，我们回顾性分析了 1987 年至 2010 年间在五个专门中心治疗的 30 例手部和足部小骨 GCT 患者。主要治疗方法是刮除术 6 例，刮除术加辅助治疗（苯酚或液氮加或不加聚甲基丙烯酸甲酯（PMMA））18 例，切除术 6 例。我们评估了并发症和复发的发生率以及影响其功能结果的因素。在平均随访 7.9 年（2 至 26 年）后，单独刮除治疗的复发率为 50%（n=3），刮除加辅助治疗的复发率为 22%（n=4），切除术的复发率为 17%（n=1）（p=0.404）。唯一的并发症是 1 例患者疼痛，经手术切除 PMMA 残留后缓解。我们无法确定任何与更高并发症或复发率相关的个体因素。包括单独刮除和刮除加辅助治疗在内的局灶性治疗后，术后肌肉骨骼肿瘤学会评分略高于切除术（分别为 29（20 至 30）和 25（15 至 30））（p=0.091）。反复用辅助剂刮除最终治愈了所有患者，因此是手部和足部小骨原发性和复发性 GCT 的合理治疗方法。
