Weschenfelder Wolfram, Abrahams John M, Johnson Luke J
South Australian Bone and Soft Tissue Tumour Unit, Discipline of Orthopaedic Surgery, Flinders University and Flinders Medical Centre, Adelaide, Australia.
Department of Trauma, Hand and Reconstructive Surgery, University Hospital Jena, Am Klinikum 1, D-07747, Jena, Germany.
World J Surg Oncol. 2021 Feb 2;19(1):37. doi: 10.1186/s12957-021-02143-3.
Denosumab (Xgeva) is a fully human antibody to RANK-Ligand, an important signal mediator in the pathogenesis of giant cell tumour of bone (GCTB). The use of denosumab in the treatment of GCTB has changed the way in which these tumours are managed over the past years.
Described is the case of an acute fracture through a GCTB of the distal radius of a fit and well 32-year-old, non-smoking, female patient following a simple fall onto her outstretched, dominant hand. The aim was to enable joint sparing management for the patient, as opposed to an acute fusion procedure of the carpus. The patient underwent percutaneous k-wire fixation with application of plaster and immediate commencement with denosumab to halt the activity of the GCTB. Bone healing was rapid; plaster and k-wires were removed after 6 weeks. At 6 months denosumab, was ceased and an open curettage and grafting procedure of the tumour bed was undertaken (using MIIG X3, Wright Medical, aqueous calcium sulphate as graft material).
The use of denosumab in the acute setting of pathological fracture through giant cell tumour of bone allowing joint salvage has not been previously described. The treatment was well tolerated and functional outcomes are excellent, with very promising 4-year follow-up. This novel approach may allow for more joint sparing strategies in the future for other patients in this difficult situation. Further cases will need to be gathered to establish this technique as a suitable treatment pathway.
地诺单抗（Xgeva）是一种完全人源化的抗核因子κB受体活化因子配体（RANK-Ligand）抗体，RANK-Ligand是骨巨细胞瘤（GCTB）发病机制中的一种重要信号介质。在过去几年中，地诺单抗在GCTB治疗中的应用改变了这些肿瘤的治疗方式。
本文描述了一名32岁、身体健康、不吸烟的女性患者，在一次简单的伸展优势手摔倒后，桡骨远端GCTB发生急性骨折的病例。目的是为患者实施保留关节的治疗，而非腕关节急性融合手术。患者接受了经皮克氏针固定并应用石膏，同时立即开始使用地诺单抗以抑制GCTB的活性。骨折愈合迅速；6周后拆除石膏和克氏针。在使用地诺单抗6个月后停药，并对肿瘤床进行了开放刮除和植骨手术（使用Wright Medical公司的MIIG X3硫酸钙水溶液作为植骨材料）。
地诺单抗在骨巨细胞瘤导致的病理性骨折急性情况下用于保留关节的治疗此前尚未见报道。该治疗耐受性良好，功能预后极佳，4年随访结果非常有前景。这种新方法可能会为未来处于这种困难情况的其他患者提供更多保留关节的策略。需要收集更多病例以确立该技术作为一种合适的治疗途径。
