骨巨细胞瘤病灶内广泛刮除、烧灼及聚甲基丙烯酸甲酯骨水泥填充治疗的中期结果：一项回顾性病例系列研究。
Mid-term results of intralesional extended curettage, cauterization, and polymethylmethacrylate cementation in the treatment of giant cell tumor of bone: A retrospective case series.
机构信息
Department of Orthopaedic Surgery and Traumatology, Marmara University, School of Medicine, İstanbul, Turkey.
出版信息
Acta Orthop Traumatol Turc. 2020 Sep;54(5):524-529. doi: 10.5152/j.aott.2020.19082.
OBJECTIVE
The aim of this study was to present the mid-term functional outcomes and recurrence rate in patients with giant cell tumor of bone (GCTB) treated by intralesional extended curettage, electrocauterization, and polymethylmethacrylate (PMMA) cementation.
METHODS
In this retrospective observational study, 79 consecutive patients (41 females, 38 males; mean age=39 years; age range=19-62 years) who were diagnosed and treated for GCTB between 2005 and 2017 were identified from hospital medical records. All patients were treated by intralesional extended curettage using high-speed burr, electrocauterization of the cavity, and filling the defect with PMMA. No additional local adjuvants were used. The mean follow-up period was 47 months (range=24-96). The tumors were graded according to the radiological classification system described by Campanacci. Functional outcomes were evaluated using the Musculoskeletal Tumor Society Score (MSTS) preoperatively, one year postoperatively, and at the final follow-up. Postoperative complications and recurrence rates were recorded.
RESULTS
Twenty-nine tumors were located in the distal femur, 23 in the proximal tibia, nine in the distal radius, five in the proximal humerus, five in the pelvis, three in the proximal fibula, two in the distal ulna, two in the distal tibia, and one in the second metatarsal. According to Campanacci classification, 37 tumors were grade III, 32 grade II, and 10 grade I. The mean MSTS score was 46.1% (range 40.2 to 71.4%) preoperatively, 91.7% (range 73.3% to 100%) one year postoperatively, and 86.3 % (range 66.2% to 96,1%) at the final follow-up. The overall complication rate was 7.6%; which included local tumor recurrence in four patients, superficial wound infection in one, and deep wound infection in another. The recurrence rate was 5.1% (4 patients). Recurrent tumors were located at the distal femur in three patients and proximal tibia in one.
CONCLUSION
With satisfactory functional results and low recurrence rates at the mid-term follow-up, GCTB can be treated effectively with intralesional extended curettage, electrocauterization, and PMMA cementation.
LEVEL OF EVIDENCE
Level IV, Therapeutic study.
目的
本研究旨在介绍采用病灶内广泛切除、电灼和聚甲基丙烯酸甲酯（PMMA）骨水泥填充治疗骨巨细胞瘤（GCTB）患者的中期功能结果和复发率。
方法
在这项回顾性观察研究中，从医院病历中确定了 79 名连续患者（41 名女性，38 名男性；平均年龄 39 岁；年龄范围 19-62 岁），这些患者在 2005 年至 2017 年间被诊断为 GCTB 并接受治疗。所有患者均采用高速磨头进行病灶内广泛切除、电灼、PMMA 填充骨腔。未使用其他局部辅助剂。平均随访时间为 47 个月（范围 24-96）。肿瘤根据 Campanacci 放射学分类系统分级。术前、术后 1 年和最终随访时使用肌肉骨骼肿瘤学会评分（MSTS）评估功能结果。记录术后并发症和复发率。
结果
29 个肿瘤位于股骨远端，23 个位于胫骨近端，9 个位于桡骨远端，5 个位于肱骨近端，5 个位于骨盆，3 个位于腓骨近端，2 个位于尺骨远端，2 个位于胫骨远端，1 个位于第二跖骨。根据 Campanacci 分级，37 个肿瘤为 III 级，32 个为 II 级，10 个为 I 级。术前平均 MSTS 评分为 46.1%（范围 40.2-71.4%），术后 1 年为 91.7%（范围 73.3%-100%），最终随访时为 86.3%（范围 66.2%-96.1%）。总体并发症发生率为 7.6%；包括 4 例局部肿瘤复发，1 例浅表伤口感染，1 例深部伤口感染。复发率为 5.1%（4 例）。复发性肿瘤位于 3 例患者的股骨远端和 1 例患者的胫骨近端。
结论
在中期随访时，具有令人满意的功能结果和较低的复发率，骨巨细胞瘤可以通过病灶内广泛切除、电灼和 PMMA 骨水泥填充进行有效治疗。
证据水平
IV 级，治疗研究。
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