Deslivia Maria Florencia, Savio Sherly Desnita, Dharmapradita Made Wahyu, Wiratnaya I Gede Eka
Orthopaedics and Traumatology Department, Faculty of Medicine Udayana University, Sanglah General Hospital, Denpasar, Indonesia.
Open Access Maced J Med Sci. 2019 Oct 12;7(21):3721-3725. doi: 10.3889/oamjms.2019.731. eCollection 2019 Nov 15.
Although major reconstructive surgeries in the form of excision and reconstruction have been the mainstay treatment for Giant Cell Tumour (GCT) of the bone, its recurrence rate remains high and poses various morbidities such as implant failure or skin breakdown. Minimal invasive surgery (MIS) techniques, which has gained popularity mostly in other fields in orthopaedic surgery, are being introduced as an alternative to limit the surgical complications while achieving the best possible outcome. Until now, there has been no literature summarising the evidence of MIS outcome in treating GCT of the bone.
The purpose of this systematic review was to investigate the efficacy of this relatively new treatment.
We comprehensively searched PubMed, EMBASE, and Cochrane Library to search for studies about MIS for GCT of the bone treatment up to March 1, 2019. The selection of appropriate studies was performed by two independent investigators based on PRISMA guideline. Given the limited number of studies, there was no restriction in terms of patient's demographics, the specific minimally invasive surgical method, and publication status.
We found 120 articles from the database. After evaluating full text, 5 articles (16 patients) were found to be eligible. The minimally invasive methods were curettage, cryosurgery, and argon beam coagulator. The visualisation methods include a computer-assisted navigation system, endoscope, otoscope, CT, and MRI. Location of tumours includes axial and long bones. The follow-up period ranges from 7 to 126 months. The functional and oncological outcome was found to be satisfying with no recurrence or complications.
In conclusion, MIS is a familiar method in orthopaedic surgery with potential expansion in tumour field. The current evidence shows that this approach for GCT results in good functional outcome, with low risk of recurrence.
尽管以切除和重建为主的大型重建手术一直是骨巨细胞瘤（GCT）的主要治疗方法，但其复发率仍然很高，并会引发各种并发症，如植入物失败或皮肤破损。微创外科手术（MIS）技术在骨科手术的其他领域已广受欢迎，目前正被引入作为一种替代方法，以在实现最佳治疗效果的同时限制手术并发症。到目前为止，尚无文献总结MIS治疗骨巨细胞瘤的疗效证据。
本系统评价的目的是研究这种相对较新的治疗方法的疗效。
我们全面检索了PubMed、EMBASE和Cochrane图书馆，以查找截至2019年3月1日有关MIS治疗骨巨细胞瘤的研究。由两名独立研究人员根据PRISMA指南进行适当研究的筛选。鉴于研究数量有限，对患者的人口统计学、具体的微创外科手术方法和发表状态均无限制。
我们从数据库中找到了120篇文章。在评估全文后，发现5篇文章（16例患者）符合要求。微创方法包括刮除术、冷冻手术和氩束凝固器。可视化方法包括计算机辅助导航系统、内窥镜、耳镜、CT和MRI。肿瘤位置包括轴骨和长骨。随访期为7至126个月。功能和肿瘤学结果令人满意，无复发或并发症。
总之，MIS是骨科手术中一种为人熟知的方法，在肿瘤领域有潜在的扩展应用。目前的证据表明，这种治疗骨巨细胞瘤的方法功能效果良好，复发风险低。
