Tsukamoto Shinji, Mavrogenis Andreas F, Tanzi Piergiuseppe, Leone Giulio, Righi Alberto, Akahane Manabu, Kido Akira, Honoki Kanya, Tanaka Yasuhito, Donati Davide Maria, Errani Costantino
Department of Orthopaedic Surgery, Nara Medical University, Kashihara, Nara, Japan.
First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
J Surg Oncol. 2019 Jun;119(7):864-872. doi: 10.1002/jso.25391. Epub 2019 Feb 7.
There are conflicting reports for the outcome of the patients with giant cell tumor of bone (GCTB) and pathological fracture at presentation treated with curettage or resection. This study compared local recurrence, complications, and function after curettage versus resection for these patients.
We retrospectively studied the files of 46 patients with histologically confirmed GCTB of the extremities admitted and treated from 1982 to 2015. The median follow-up was 79.5 months (57.0-125.5 months). We evaluated local recurrence and type of surgery-related complications with imaging and function with the Musculoskeletal Tumor Society (MSTS) score.
Overall local recurrence was 6.5%. There were one patient with curettage and two patients with resection; local recurrence rate was similar between the two procedures but the time to local recurrence was shorter after curettage. MSTS score was significantly better after curettage. Complications occurred in two patients after curettage and in five patients after resection; because of the low number of patients with complications, a statistical comparison was not possible; however, by direct comparison of the numbers, complications were more common after resection compared with curettage.
Curettage is recommended for GCTB and pathological fracture at presentation because of similar local recurrence but better function compared with resection. The treating physicians should be aware and inform their patients for a shorter time to local recurrence after curettage and for more complications after resection.
对于骨巨细胞瘤（GCTB）合并病理性骨折且初次就诊时接受刮除术或切除术治疗的患者，其治疗结果的报道存在矛盾。本研究比较了这些患者接受刮除术与切除术治疗后的局部复发情况、并发症及功能。
我们回顾性研究了1982年至2015年收治并治疗的46例组织学确诊为四肢GCTB患者的病历。中位随访时间为79.5个月（57.0 - 125.5个月）。我们通过影像学评估局部复发及手术相关并发症类型，并采用肌肉骨骼肿瘤学会（MSTS）评分评估功能。
总体局部复发率为6.5%。刮除术组有1例患者复发，切除术组有2例患者复发；两组手术的局部复发率相似，但刮除术后局部复发时间较短。刮除术后MSTS评分明显更好。刮除术后有2例患者出现并发症，切除术后有5例患者出现并发症；由于并发症患者数量较少，无法进行统计学比较；然而，通过直接比较数量，与刮除术相比，切除术后并发症更常见。
对于初次就诊时的GCTB合并病理性骨折，推荐采用刮除术，因为与切除术相比，局部复发率相似，但功能更好。治疗医生应告知患者刮除术后局部复发时间较短，而切除术后并发症较多。
