Tuntarattanapong Pakjai, Piakong Pongsiri, Chobpenthai Thanapon, Sukanthanak Bhasanan, Kiatisevi Piya
Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Orthopaedic Oncology Unit, Institute of Orthopaedics, Lerdsin Hospital, Bangkok, Thailand.
Eur J Orthop Surg Traumatol. 2023 Jan;33(1):135-142. doi: 10.1007/s00590-021-03168-w. Epub 2021 Nov 25.
Our objectives were (1) to compare the recurrence, metastases, and complication rates of patients with Enneking stage 3 GCTB who underwent extended curettage vs wide resection and (2) examine the factors which might influence surgical options for each patient.
We retrospectively reviewed the records of patients with Enneking stage 3 GCTB from January 2006-December 2015. Extended curettage was performed in patients in whom there was a moderate expansile lesion, minimal/no articular cartilage damage, and less than 50% of cortical deformation compared to its circumference from a CT scan/MRI. The percentages of cortical deformation were collected. Surgical complications, recurrence, and metastatic rates were analyzed.
There were 28 extended curettage and 41 wide resections. The mean percentages of cortical deformation compared to circumference were 52.6% (range, 23.9-81.9%) and 91.6% (range, 52.1-100%)(P < 0.01) for the curettage and wide resection groups, respectively. There were three recurrences, 2/28 (7.1%) from the curettage group and 1/41 (2.4%) from the resection group (P = 0.56). There were no cases of pulmonary metastasis. There were two complications in the curettage group and five complications in the resection group.
Both extended curettage and wide resection are useful methods to treat Enneking stage 3 GCTB. Extended curettage with proper technique is a viable option showing no difference in local recurrence rate and potentially fewer complications. Preference to do extended curettage in patients in whom when the articular cartilage has minimal or no destruction, a moderate expansile lesion and the cortical deformation is less than 50% of the circumference.
我们的目标是(1)比较接受扩大刮除术与广泛切除术的Enneking 3期骨巨细胞瘤患者的复发、转移和并发症发生率，以及(2)研究可能影响每位患者手术选择的因素。
我们回顾性分析了2006年1月至2015年12月期间Enneking 3期骨巨细胞瘤患者的病历。对于CT扫描/MRI显示为中度膨胀性病变、关节软骨损伤轻微/无损伤且皮质变形小于其周长50%的患者，实施扩大刮除术。收集皮质变形的百分比。分析手术并发症、复发率和转移率。
28例行扩大刮除术，41例行广泛切除术。扩大刮除术组和广泛切除术组与周长相比的皮质变形平均百分比分别为52.6%（范围23.9 - 81.9%）和91.6%（范围52.1 - 100%）(P < 0.01)。有3例复发，扩大刮除术组2/28例（7.1%），切除术组1/41例（2.4%）(P = 0.56)。无肺转移病例。扩大刮除术组有2例并发症，切除术组有5例并发症。
扩大刮除术和广泛切除术都是治疗Enneking 3期骨巨细胞瘤的有效方法。采用适当技术的扩大刮除术是一种可行的选择，局部复发率无差异且潜在并发症较少。对于关节软骨破坏轻微或无破坏、有中度膨胀性病变且皮质变形小于周长50%的患者，优先选择扩大刮除术。
