Ming Lin, Jingqian Chen, Zhongyu Xia, Meifeng Guo, Bingqing Guo, Yu Wang, Jiaxuan Zou, Jianda Xu
Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China.
Department of Orthopaedics, Changzhou Hospital Affiliated to Nanjing University of Chinese Medicine, Changzhou, Jiangsu Province, China.
Jt Dis Relat Surg. 2025 Jan 2;36(1):31-38. doi: 10.52312/jdrs.2024.1801. Epub 2024 Dec 18.
This study was to evaluate the radiological and clinical outcomes of patients with juxta-articular giant-cell tumors (GCTs) around the knee treated with bone cement filling and internal fixation after extensive curettage.
A total of 15 patients (6 males, 9 females; mean age: 35.3±8.4 years; range, 24 to 53 years) with juxta-articular GCTs around the knee were retrospectively reviewed between January 2010 and June 2020. Wound healing, functional status as assessed by the Musculoskeletal Tumor Society (MSTS) scores, local recurrence, metastasis, and complications were evaluated.
The mean follow-up was 41.3±9.9 (range, 24 to 69) months with an overall survival of 93.3%. The mean distance between tumor and cartilage was 6.29±3.73 mm. Five patients underwent reconstruction with cancellous allografts and the mean distance between tumor and cartilage was 2.20±1.48 mm in these patients. At the final follow-up, three patients had Kellgren-Lawrence Grade 2 tibiofemoral osteoarthritis in the operated knee. Lucent zones around the bone cement with no further progression were found in five patients. One patient experienced recurrence 17 months after surgery and was treated by en-bloc resection and reconstructed with a tumor endoprosthesis. The remaining 14 patients had a mean MSTS score of 26.86±2.11 (range, 23 to 30) at the final follow-up. The mean overall range of motion at the final follow-up was 109.20±14.20° (range, 85 to 130°).
Bone cement filling and internal fixation after extensive curettage is a viable strategy for accessing juxta-articular GCTs around the knee. The choice of local adjuvants, subchondral bone grafting, and the thickness of subchondral bone require more attention to preserve the continuity of articular cartilage.
本研究旨在评估经广泛刮除后骨水泥填充及内固定治疗膝关节周围近关节巨细胞瘤（GCT）患者的影像学和临床疗效。
回顾性分析2010年1月至2020年6月期间15例膝关节周围近关节GCT患者（男6例，女9例；平均年龄：35.3±8.4岁；范围24至53岁）。评估伤口愈合情况、采用肌肉骨骼肿瘤学会（MSTS）评分评估功能状态、局部复发、转移及并发症情况。
平均随访时间为41.3±9.9（范围24至69）个月，总生存率为93.3%。肿瘤与软骨的平均距离为6.29±3.73毫米。5例患者采用松质骨同种异体骨重建，这些患者肿瘤与软骨的平均距离为2.20±1.48毫米。末次随访时，3例患者手术膝关节出现Kellgren-Lawrence 2级胫股关节炎。5例患者在骨水泥周围发现透亮区且无进一步进展。1例患者术后17个月复发，行整块切除并用肿瘤假体重建。其余14例患者末次随访时MSTS评分平均为26.86±2.11（范围23至30）。末次随访时平均总体活动范围为109.20±14.20°（范围85至130°）。
广泛刮除后骨水泥填充及内固定是治疗膝关节周围近关节GCT的可行策略。局部辅助治疗的选择、软骨下骨移植及软骨下骨厚度需要更多关注以保持关节软骨的连续性。
