Department of Orthopaedic Surgery, Nara Medical University, 840g, Shijo-cho, Kashihara-city, Nara, 634-8521, Japan.
First Department of Orthopaedics, National and Kapodistrian University of Athens, School of Medicine, 41 Ventouri Street, 15562 Holargos, Athens, Greece.
BMC Musculoskelet Disord. 2022 May 19;23(1):477. doi: 10.1186/s12891-022-05447-x.
Following curettage of giant cell tumor of bone (GCTB), it is common to fill the cavity with polymethylmethacrylate (PMMA) bone cement, bone allograft, or artificial bone to maintain bone strength; however, there is a 2-14% risk of postoperative fractures. We conducted this retrospective study to clarify the risk factors for fractures after curettage for GCTB of the extremities.
This study included 284 patients with GCTBs of the extremities who underwent curettage at our institutions between 1980 and 2018 after excluding patients whose cavities were not filled with anything or who had additional plate fixation. The tumor cavity was filled with PMMA bone cement alone (n = 124), PMMA bone cement and bone allograft (n = 81), bone allograft alone (n = 63), or hydroxyapatite graft alone (n = 16).
Fractures after curettage occurred in 10 (3.5%) patients, and the median time from the curettage to fracture was 3.5 months (interquartile range [IQR], 1.8-8.3 months). The median postoperative follow-up period was 86.5 months (IQR, 50.3-118.8 months). On univariate analysis, patients who had GCTB of the proximal or distal femur (1-year fracture-free survival, 92.5%; 95% confidence interval [CI]: 85.8-96.2) presented a higher risk for postoperative fracture than those who had GCTB at another site (100%; p = 0.0005). Patients with a pathological fracture at presentation (1-year fracture-free survival, 88.2%; 95% CI: 63.2-97.0) presented a higher risk for postoperative fracture than those without a pathological fracture at presentation (97.8%; 95% CI: 95.1-99.0; p = 0.048). Patients who received bone grafting (1-year fracture-free survival, 99.4%; 95% CI: 95.7-99.9) had a lower risk of postoperative fracture than those who did not receive bone grafting (94.4%; 95% CI: 88.7-97.3; p = 0.003).
For GCTBs of the femur, especially those with pathological fracture at presentation, bone grafting after curettage is recommended to reduce the risk of postoperative fracture. Additional plate fixation should be considered when curettage and cement filling without bone grafting are performed in patients with GCTB of the femur. This should be specially performed for those patients with a pathological fracture at presentation.
在骨巨细胞瘤（GCTB）刮除术后，通常使用聚甲基丙烯酸甲酯（PMMA）骨水泥、骨移植物或人造骨填充空腔以维持骨强度；然而，术后骨折的风险为 2-14%。我们进行这项回顾性研究，以明确四肢 GCTB 刮除术后骨折的危险因素。
本研究纳入了 1980 年至 2018 年间在我们机构接受 GCTB 刮除术的 284 例四肢 GCTB 患者，排除了空腔未填充任何物质或接受附加钢板固定的患者。肿瘤空腔单独用 PMMA 骨水泥填充（n=124），PMMA 骨水泥和骨移植物（n=81），骨移植物单独填充（n=63）或单独使用羟基磷灰石移植物填充（n=16）。
10 例（3.5%）患者在刮除术后发生骨折，从刮除到骨折的中位时间为 3.5 个月（四分位间距 [IQR]，1.8-8.3 个月）。中位术后随访时间为 86.5 个月（IQR，50.3-118.8 个月）。单因素分析显示，股骨近端或远端 GCTB 患者（1 年无骨折生存率为 92.5%；95%置信区间 [CI]：85.8-96.2）比其他部位 GCTB 患者（100%；p=0.0005）术后骨折风险更高。初诊时病理性骨折患者（1 年无骨折生存率为 88.2%；95%CI：63.2-97.0）比初诊时无病理性骨折患者（97.8%；95%CI：95.1-99.0；p=0.048）术后骨折风险更高。接受植骨的患者（1 年无骨折生存率为 99.4%；95%CI：95.7-99.9）比未接受植骨的患者（94.4%；95%CI：88.7-97.3；p=0.003）术后骨折风险更低。
对于股骨 GCTB，尤其是初诊时存在病理性骨折的患者，建议在刮除术后进行植骨，以降低术后骨折的风险。对于股骨 GCTB 患者，在进行刮除和无植骨的骨水泥填充时，应考虑附加钢板固定。对于那些初诊时存在病理性骨折的患者，尤其应进行该操作。
