Department of Orthopedic Surgery, Leiden University Medical Center, Postzone J11-R70, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail address for L. van der Heijden:
Department of Orthopedic Surgery, Radboud University Medical Center, Postzone 357, PO Box 9101, 6505 HB Nijmegen, The Netherlands.
J Bone Joint Surg Am. 2014 Mar 5;96(5):e35. doi: 10.2106/JBJS.M.00516.
The rate of recurrence of giant cell tumor of bone is decreased by use of adjuvant treatments such as phenol, liquid nitrogen, or polymethylmethacrylate (PMMA) during curettage. We assessed recurrence and complication rates and functional outcome after curettage with use of phenol and PMMA, liquid nitrogen and PMMA, and liquid nitrogen and bone grafts.
We retrospectively compared the relative effectiveness of treatment of giant cell tumors of bone at two tertiary centers with a regional function from 1990 to 2010. The 132 (of 201) patients who met the inclusion criteria had a mean age of thirty-three years (range, eleven to sixty-nine years). Treatment assignment depended purely on the center, with primary treatment consisting of curettage with use of phenol and PMMA (n = 82) at one center and with use of either liquid nitrogen and PMMA (n = 26) or liquid nitrogen and bone grafts (n = 24) at the other center. Recurrence and complication rates were determined, and functional outcome was assessed on the basis of the Musculoskeletal Tumor Society (MSTS) score.
The mean duration of follow-up was eight years (range, two to twenty-two years). Recurrence rates were comparable among the groups (28% for phenol and PMMA, 31% for liquid nitrogen and PMMA, and 38% for liquid nitrogen and bone grafts; p = 0.52). Soft-tissue extension increased the recurrence risk (hazard ratio [HR] = 2.1, 95% confidence interval [CI] = 1.1 to 4.0, p = 0.024). The complication rate was 33% after use of liquid nitrogen and bone grafts, 27% after liquid nitrogen and PMMA, and 11% after phenol and PMMA (p = 0.019); complications included osteoarthritis, infection, postoperative fracture, nonunion, transient nerve palsy, and PMMA leakage. The complication risk was increased by the presence of a pathologic fracture (HR = 4.1, 95% CI = 1.7 to 9.5, p = 0.001) and use of liquid nitrogen (HR = 3.9, 95% CI = 1.5 to 10, p = 0.006 for liquid nitrogen and bone grafts; HR = 3.1, 95% CI = 1.1 to 8.6, p = 0.028 for liquid nitrogen and PMMA). The mean MSTS score was 26 (range, 8 to 30) and was comparable among all three groups (p = 0.52).
Recurrence rates were comparable for treatment with phenol and PMMA, liquid nitrogen and PMMA, and liquid nitrogen and bone grafts. Complication rates were higher after use of liquid nitrogen. The functional outcome was excellent in all three cohorts.
通过在刮除术中使用苯酚、液氮或聚甲基丙烯酸甲酯（PMMA）等辅助治疗，可以降低骨巨细胞瘤的复发率。我们评估了在两个三级中心使用苯酚和 PMMA、液氮和 PMMA 以及液氮和骨移植物进行刮除术后的复发和并发症发生率以及功能结果。
我们回顾性比较了 1990 年至 2010 年期间两个具有区域功能的三级中心治疗骨巨细胞瘤的相对效果。符合纳入标准的 201 名患者中有 132 名（占 132 名），平均年龄 33 岁（范围 11 至 69 岁）。治疗分配纯粹取决于中心，在一个中心，主要治疗方法是使用苯酚和 PMMA 进行刮除术（n = 82），在另一个中心使用液氮和 PMMA（n = 26）或液氮和骨移植物（n = 24）。确定了复发和并发症发生率，并根据肌肉骨骼肿瘤学会（MSTS）评分评估了功能结果。
平均随访时间为 8 年（范围 2 至 22 年）。各组的复发率相当（苯酚和 PMMA 组为 28%，液氮和 PMMA 组为 31%，液氮和骨移植物组为 38%；p = 0.52）。软组织延伸增加了复发风险（风险比[HR] = 2.1，95%置信区间[CI] = 1.1 至 4.0，p = 0.024）。液氮和骨移植物组的并发症发生率为 33%，液氮和 PMMA 组为 27%，苯酚和 PMMA 组为 11%（p = 0.019）；并发症包括骨关节炎、感染、术后骨折、骨不连、短暂性神经麻痹和 PMMA 渗漏。病理性骨折（HR = 4.1，95%CI = 1.7 至 9.5，p = 0.001）和使用液氮（HR = 3.9，95%CI = 1.5 至 10，p = 0.006 用于液氮和骨移植物；HR = 3.1，95%CI = 1.1 至 8.6，p = 0.028 用于液氮和 PMMA）会增加并发症风险。MSTS 平均得分为 26（范围 8 至 30），在所有三组中均相当（p = 0.52）。
苯酚和 PMMA、液氮和 PMMA 以及液氮和骨移植物治疗的复发率相当。使用液氮后并发症发生率较高。所有三组的功能结果均为优秀。
