Khan A Q, Raza Q, Abbas M B, Chowdhry M, Khan M J
Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College and Hospital, Aligarh, India.
Malays Orthop J. 2024 Nov;18(3):42-50. doi: 10.5704/MOJ.2411.006.
Recurrence after Giant Cell Tumour (GCT) treatment depends on the type of treatment used. Poly-Methyl-Meth-Acrylate (PMMA) after extended curettage provides structural support and allows for early identification of recurrence but carries a risk of thermal damage to the surrounding healthy tissue. The aim of this study was to compare long-term functional outcomes and complications in patients with GCT around the knee treated with extended curettage and bone grafting or cementation.
All patients with biopsy-proven GCT, involving either the distal femur or proximal tibia, and treated with either curettage with bone grafting (CBG), curettage with bone cementation (CBC), or curettage combined with grafting and cementation (the Sandwich technique) were included. They were further classified according to Campanacci grading. Patients were followed for a minimum of two years, and all complications were recorded.
The three groups showed a statistically significant difference in terms of persistent pain after surgery (p=0.03), development of long-term arthritis (p=0.01), as well as overall complications (p=0.005). There was no significant difference in terms of the overall recurrence rate between each group (p>0.05). For Campanacci Grade II lesions, there was a statistically significant difference in terms of local recurrence (p=0.01), with lower recurrence rates observed after cementation procedures.
The study indicates that the Sandwich technique was associated with a lower rate of complications compared to CBG or CBC. Patients in the CBG group reported persistent pain, while those in the CBC group exhibited early arthritic changes within five years of the index surgery. Although there was no overall difference in recurrence rates, cementation procedures had a significantly lower rate of recurrence in Campanacci Grade II lesions.
骨巨细胞瘤（GCT）治疗后的复发取决于所采用的治疗类型。扩大刮除术后使用聚甲基丙烯酸甲酯（PMMA）可提供结构支撑并有助于早期发现复发，但存在对周围健康组织造成热损伤的风险。本研究的目的是比较采用扩大刮除术联合植骨或骨水泥填充治疗的膝关节周围骨巨细胞瘤患者的长期功能结局和并发症。
纳入所有经活检证实为骨巨细胞瘤、累及股骨远端或胫骨近端、并接受刮除植骨（CBG）、刮除骨水泥填充（CBC）或刮除联合植骨与骨水泥填充（三明治技术）治疗的患者。根据坎帕纳奇分级进一步分类。对患者进行至少两年的随访，并记录所有并发症。
三组在术后持续疼痛（p = 0.03）、长期关节炎的发生（p = 0.01）以及总体并发症（p = 0.005）方面存在统计学显著差异。各组之间的总体复发率无显著差异（p>0.05）。对于坎帕纳奇II级病变，局部复发方面存在统计学显著差异（p = 0.01），骨水泥填充术后复发率较低。
该研究表明，与CBG或CBC相比，三明治技术的并发症发生率较低。CBG组患者报告有持续疼痛，而CBC组患者在初次手术五年内出现早期关节炎改变。虽然复发率总体上没有差异，但在坎帕纳奇II级病变中，骨水泥填充术的复发率显著较低。
