足踝部腱鞘巨细胞瘤的治疗结果
Outcomes of Tenosynovial Giant Cell Tumor of the Foot and Ankle.
作者信息
Barnett James Robert, Rudran Branavan, Khan Amir, O'Reilly-Harbidge Sarah, Patel Shelain, Malhotra Karan, Cullen Nicholas, Welck Matthew, Aston William
机构信息
Royal National Orthopaedic Hospital NHS Trust, Stanmore, United Kingdom.
East and North Hertfordshire NHS Trust, Stevenage, United Kingdom.
出版信息
Foot Ankle Int. 2023 Oct;44(10):1013-1020. doi: 10.1177/10711007231189491. Epub 2023 Aug 30.
BACKGROUND
Tenosynovial giant cell tumor (TGCT) is a benign proliferative disease affecting synovial membranes. There are 2 forms, localized (L-TGCT) and diffuse (D-TGCT), which although histologically similar behave differently. It is locally invasive and is treated in most cases by operative excision. The aim of this study was to assess current practice, how the patients' presentation affected their outcome, as well as review the recurrence rates and complications.
METHODS
A retrospective analysis of 123 cases was performed in patients treated between 2003 and 2019 with TGCT of the foot and/or ankle. Data were collected on age at presentation, radiologic pattern of disease, location of disease, treatment provided, and recurrence rates. The minimum follow-up was 2 years with a mean of 7.7 years.
RESULTS
There were 61.7% female patients with a mean age of 39 (range, 11-76) years. L-TGCT accounted for 85 (69.1%) cases and D-TGCT for 38 (30.9%). The most prevalent preoperative symptoms were a palpable mass (78/123) and pain (65/123). Radiologically confirmed recurrence in the operative group was noted in 14.5% (16/110) cases. This comprised 4% (3/75) of operatively treated L-TGCT and 37% (13/35) of operatively treated D-TGCT. Patients with pain on presentation and those with erosive changes on presenting magnetic resonance imaging (MRI) were more likely to have persistent postoperative pain ( < .001 for both). Where patients had both preoperative pain and erosive changes, 57.1% had postoperative pain. Thirteen cases were managed nonoperatively where symptoms were minimal, with 1 case requiring surgery at a later date.
CONCLUSION
Outcomes of TGCT management are dependent on the disease type, extent of preoperative erosive changes, and presence of preoperative pain. These data are useful for counseling patients regarding the outcomes of surgical intervention and help guide the timing of intervention.
LEVEL OF EVIDENCE
Level III, retrospective cohort study.
背景
腱鞘巨细胞瘤（TGCT）是一种影响滑膜的良性增殖性疾病。它有两种形式，局限性（L-TGCT）和弥漫性（D-TGCT），尽管在组织学上相似，但行为方式不同。它具有局部侵袭性，大多数情况下通过手术切除进行治疗。本研究的目的是评估当前的治疗实践、患者的表现如何影响其预后，以及回顾复发率和并发症。
方法
对2003年至2019年间接受足部和/或踝关节TGCT治疗的123例患者进行回顾性分析。收集了患者就诊时的年龄、疾病的放射学模式、疾病部位、所提供的治疗以及复发率等数据。最小随访时间为2年，平均随访时间为7.7年。
结果
女性患者占61.7%，平均年龄为39岁（范围11 - 76岁）。L-TGCT占85例（69.1%），D-TGCT占38例（30.9%）。术前最常见的症状是可触及肿块（78/123）和疼痛（65/123）。手术组经放射学证实的复发率为14.5%（16/110）。这包括手术治疗的L-TGCT中的4%（3/75）和手术治疗的D-TGCT中的37%（13/35）。就诊时疼痛的患者以及在初次磁共振成像（MRI）上有侵蚀性改变的患者术后更有可能持续疼痛（两者均P <.001）。术前既有疼痛又有侵蚀性改变的患者中，57.1%术后疼痛。13例症状轻微的患者采用非手术治疗，其中1例后来需要手术。
结论
TGCT的治疗结果取决于疾病类型、术前侵蚀性改变的程度以及术前疼痛的存在情况。这些数据有助于向患者提供有关手术干预结果的咨询，并有助于指导干预时机。
证据水平
III级，回顾性队列研究。
Zotero 插件