骨巨细胞瘤病灶内刮除后使用聚甲基丙烯酸甲酯骨水泥是否能保证降低局部复发率？一项回顾性分析。

Does the use of polymethyl-methacrylate cement after intralesional curettage of giant cell tumors of appendicular bone guarantee reduced local recurrence rates? A retrospective analysis.

机构信息

Department of Orthopaedic Surgery, University of Copenhagen, Hvidovre, Denmark.

Musculoskeletal Tumor Section, Department of Orthopedic Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.

出版信息

J Orthop Surg (Hong Kong). 2023 Sep-Dec;31(3):10225536231202155. doi: 10.1177/10225536231202155.

DOI:10.1177/10225536231202155

PMID:37688488

Abstract

PURPOSE

Polymethyl-methacrylate cement (PMMA) is often used as bone defect reconstruction material after surgical removal of giant cell tumors. The purpose of this study was to investigate if the application of PMMA improves the local recurrence rates for giant cell tumors (GCT) of appendicular bone treated with intralesional curettage.

METHODS

A retrospective analysis of all appendicular GTCs treated at two major Danish sarcoma centres between the 1 of January 1998 and December 31 2013; minimum follow-up of 3.0 years (median: 8.9; 1.3-18.7 years). Kaplan-Meier survival model, log-rank and multivariate Cox regression were used to calculate and compare local recurrence rates. -values <0.05 were considered statistically significant.

RESULTS

102 patients (M59/F43), median age 31Y (11-84) were included in this study. The overall 3-years local recurrence-rate was 19.9% (95%CI: 11.9-27.9%); 91% had occurred within 3 years. In patients treated with intralesional curettage ( = 64), the 3-years recurrence-rate was 30.6% (95%CI: 18.8-42.4%), compared to 2.6% (95%CI: 0.0-7.8%) in patients treated with wide resection or amputation ( = 38), < .001. The 3-years recurrence-rate for patients treated with intralesional curettage and reconstruction using PMMA was 29.0% (95%CI: 12.6-45.4%) and without PMMA: 31.8% (95%CI: 15.2-48.4%), = .83.

CONCLUSION

We found that the use of PMMA for bone defect reconstruction after intralesional curettage of GTCs in the appendicular skeleton did not ensure a reduced risk of local recurrence.

摘要

目的

聚甲基丙烯酸甲酯（PMMA）水泥常被用作外科切除骨巨细胞瘤（GCT）后的骨缺损重建材料。本研究旨在探讨在肢体 GCT 采用腔内刮除术治疗后应用 PMMA 是否能降低局部复发率。

方法

回顾性分析了 1998 年 1 月 1 日至 2013 年 12 月 31 日期间在丹麦两家主要肉瘤中心治疗的所有肢体 GCT；随访时间至少 3.0 年（中位数：8.9 年；1.3-18.7 年）。Kaplan-Meier 生存模型、对数秩和多因素 Cox 回归用于计算和比较局部复发率。P 值＜0.05 为差异有统计学意义。

结果

本研究共纳入 102 例患者（男 59 例，女 43 例），中位年龄 31 岁（11-84 岁）。总的 3 年局部复发率为 19.9%（95%CI：11.9-27.9%）；91%发生在 3 年内。采用腔内刮除术治疗的患者中，3 年复发率为 30.6%（95%CI：18.8-42.4%），而采用广泛切除或截肢治疗的患者中，复发率为 2.6%（95%CI：0.0-7.8%），＜0.001。采用腔内刮除术治疗并使用 PMMA 进行骨缺损重建的患者，3 年复发率为 29.0%（95%CI：12.6-45.4%），未使用 PMMA 的患者复发率为 31.8%（95%CI：15.2-48.4%），＝0.83。