Joshi Narendra, Saini Mukesh Kumar, Prakash Anand, Mohapatra Soumya Shrikanta
Department of Orthopaedics, Sawai Man Singh Medical College, Jaipur, Rajasthan, India.
J Orthop Case Rep. 2018 Mar-Apr;8(2):16-18. doi: 10.13107/jocr.2250-0685.1028.
Giant-cell tumors (GCTs) are benign tumors of musculoskeletal system, commonly occur around knee. High-grade GCTs have a high tendency to recur after intralesional curettage. Reconstruction of joint after excision of such aggressive juxta-articular GCT has been challenging task. We describe a case of recurrence in GCT of lateral femoral condyle managed with tumor excision and pedicled patellar transplant to reconstruct the joint.
A 25-year-old male patient reported to us after 22 months after he had undergone curettage and bone grafting for GCT of lateral femoral condyle of his right knee with recurrence of primary tumor. After tumor resection, we restored the lost articular surface with musculovascular pedicled patella and managed dead space with corticocancellous bone graft and fibular strut. 2-year follow-up exhibited good functional outcome without any sign of recurrence.
Biological reconstruction with patellar transplant can be a good option for young patients in whom endoprosthesis placement poses significant concerns about longevity, cost, and revision surgeries.
骨巨细胞瘤(GCT)是肌肉骨骼系统的良性肿瘤,常见于膝关节周围。高级别骨巨细胞瘤在病灶内刮除术后复发倾向较高。切除此类侵袭性关节周围骨巨细胞瘤后进行关节重建一直是一项具有挑战性的任务。我们描述了一例股骨外侧髁骨巨细胞瘤复发的病例,通过肿瘤切除和带蒂髌骨移植来重建关节进行治疗。
一名25岁男性患者在对右膝股骨外侧髁骨巨细胞瘤进行刮除和骨移植术后22个月复发,前来就诊。肿瘤切除后,我们用带肌肉血管蒂的髌骨修复了缺失的关节面,并用皮质松质骨移植和腓骨支撑物处理了死腔。2年随访显示功能结果良好,无任何复发迹象。
对于年轻患者,髌骨移植的生物重建可能是一个不错的选择,因为放置假体对使用寿命、成本和翻修手术存在重大担忧。