Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 318, Building 86, Rishikesh, Uttarakhand, 249203, India.
Eur J Orthop Surg Traumatol. 2020 Aug;30(6):1109-1117. doi: 10.1007/s00590-020-02679-2. Epub 2020 May 1.
Giant cell tumor (GCT) of bone is a locally aggressive benign neoplasm that is associated with a wide spectrum of biological activity ranging from latent benign to highly recurrent and has occasional metastatic potential. It affects the meta-epiphyseal region of long bones of young adults with most common site involved is the distal femur, followed by the distal radius. Plain radiographs and contrast-enhanced magnetic resonance imaging are the imaging modalities widely used followed by definite histopathology for diagnosis. Surgical treatment with curettage is considered optimal for local tumor control. Tumor excision with tumor-free margins is associated with lesser recurrence rates; however, for periarticular lesions this is usually accompanied with a suboptimal functional outcome.
Eleven eligible patients (all females, mean age 39.2 years) with Campanacci grade III GCT of the distal radius who were treated by en bloc resection and reconstruction with non-vascularized proximal fibular autografts at a single centre between July 2016 and December 2017 were included in the study. The patients had a clinical and radiographic review every month for the first 6 months, then biannually for minimum of 2 years. The functional, oncologic and radiological outcomes of the patients were analyzed and recorded.
The mean duration of follow-up was 31.9 months. Bony union was achieved in all cases. The mean VAS score at 6 months was 1.1 (range 0-2). The mean Mayo Wrist score was 66.36 (range 55-80) with mean MSTS score was 21.09 (range 18-24). The average range of motion of the wrist was: 37.3° ± 6.9° of flexion, 47.1° ± 7.5° of extension, 57.3° ± 7.8° of supination and 63.6° ± 6.4° of pronation. The average graft length used was 15.6 cm. The complications noted were lung metastases which developed preoperatively, local site recurrence, wrist joint subluxation, foot drop and wound complication.
The primary aim of treating GCT distal radius is oncologically sound resection with good functional outcome and cosmesis being secondary. Reconstruction with a non-vascularized proximal fibular autograft is a reasonable option after en bloc resection of the distal radius for giant cell tumor of bone having comparable results with other treatment modalities.
骨巨细胞瘤（GCT）是一种局部侵袭性良性肿瘤，其生物学活性范围广泛，从潜伏良性到高度复发性，偶尔具有转移潜能。它影响长骨的干骺端区域，最常见的受累部位是股骨远端，其次是桡骨远端。广泛使用的影像学检查方法包括平片和增强磁共振成像，随后进行明确的组织病理学诊断。刮除术是治疗局部肿瘤的首选方法。肿瘤整块切除并保证无肿瘤切缘与较低的复发率相关，但对于关节周围病变，这通常伴随着较差的功能结局。
本研究纳入了 2016 年 7 月至 2017 年 12 月期间在单一中心接受整块切除和非血管化腓骨近端自体移植重建的 11 例 Campanacci 分级 III 型桡骨远端 GCT 的女性患者（平均年龄 39.2 岁）。在最初的 6 个月，患者每月进行一次临床和影像学复查，之后每 6 个月复查一次，至少复查 2 年。分析和记录了患者的功能、肿瘤学和影像学结果。
平均随访时间为 31.9 个月。所有患者均获得骨愈合。6 个月时的平均视觉模拟评分（VAS）为 1.1（范围 0-2）。平均 Mayo 腕关节评分 66.36（范围 55-80），平均 MSTS 评分为 21.09（范围 18-24）。腕关节平均活动范围为：屈曲 37.3°±6.9°，伸展 47.1°±7.5°，旋前 57.3°±7.8°，旋后 63.6°±6.4°。平均使用的移植物长度为 15.6cm。记录的并发症包括术前出现的肺转移、局部复发、腕关节半脱位、足下垂和伤口并发症。
治疗桡骨远端 GCT 的主要目标是在保证良好的功能和美容效果的前提下进行肿瘤学上安全的切除。整块切除桡骨后，使用非血管化腓骨近端自体移植进行重建是一种合理的选择，其结果与其他治疗方法相当。
