Hirozane Toru, Sekita Tetsuya, Kobayashi Eisuke, Mori Tomoaki, Asano Naofumi, Udaka Toru, Tajima Takashi, Nakagawa Rumi, Kikuta Kazutaka, Yoshiyama Akira, Morioka Hideo, Watanabe Itsuo, Anazawa Ukei, Susa Michiro, Horiuchi Keisuke, Suzuki Yoshihisa, Morii Takeshi, Nakayama Robert
Department of Orthopaedic Surgery, Keio University School of Medicine, Shinjuku-Ku, Tokyo, Japan.
Department of Orthopaedic Surgery, Faculty of Medicine, Kyorin University, Mitaka, Tokyo, 181-8611, Japan.
BMC Surg. 2025 Jan 24;25(1):40. doi: 10.1186/s12893-025-02782-3.
Chondroblastoma is classified as a benign bone tumor. However, postoperative local recurrence remains a concern. We analyzed the factors contributing to chondroblastoma local recurrence and the clinical challenges associated with treating these patients.
This retrospective study examined 59 patients followed up at our hospitals for ≥ 1 year after surgery during 1990-2020. The most common lesion site was the epiphyses of long bones (42 cases, 71%), including the femur, tibia, and humerus. Curettage was performed in 57 cases; 2 cases with an iliac lesion underwent resection. The median postoperative follow-up period was 47 months. Clinical features of chondroblastoma were retrospectively investigated, and local recurrence and postoperative functional outcomes were assessed.
Local recurrence occurred in 9% (5/57) of patients after curettage but not in the resected cases. The median time to local recurrence was 14 months. The local recurrence-free survival (LRFS) rate for all patients was 92.7% at 2 years and 88.3% at 5 years. All patients with local recurrence were aged < 17 years at the time of surgery. Local recurrence was observed in the proximal humerus in two cases and the calcaneus, acetabulum, and distal femur in one case each. None of the adjuvant procedures (high-speed burr, ablation, bone replacement materials, and preoperative denosumab) helped reduce local recurrence risk (P > 0.05). Trends toward fewer local recurrences were observed in the group treated using the high-speed burr and in the group not treated using bone replacement materials. Among the groups treated with bone replacement materials, artificial bone achieved the best LRFS rate, followed by allograft and autograft. At the final follow-up, the mean Musculoskeletal Tumor Society score was 29.8 (range: 25-30), indicating excellent postoperative functional outcomes. Joint degeneration was observed in five patients. Patients with local recurrence had a high degree of disability and joint deformity (P < 0.05). Two patients received preoperative denosumab and neither experienced local recurrence nor functional impairments.
Good oncological and functional outcomes were achieved. Age < 17 years was associated with a high risk of local recurrence after curettage (P = 0.0198). Patients with local recurrence exhibited poorer functional outcomes. High-speed burr may help reduce the recurrence risk. If bone grafts are necessary, materials with low biocompatibility, including artificial bone, may be optimal. Managing patients with chondroblastoma should encompass curative and functional aspects.
软骨母细胞瘤被归类为良性骨肿瘤。然而，术后局部复发仍是一个令人担忧的问题。我们分析了导致软骨母细胞瘤局部复发的因素以及治疗这些患者所面临的临床挑战。
这项回顾性研究检查了1990年至2020年间在我们医院接受手术且术后随访≥1年的59例患者。最常见的病变部位是长骨骨骺（42例，71%），包括股骨、胫骨和肱骨。57例行刮除术；2例髂骨病变患者行切除术。术后中位随访期为47个月。回顾性研究软骨母细胞瘤的临床特征，并评估局部复发情况和术后功能结果。
刮除术后9%（5/57）的患者出现局部复发，而切除病例未出现复发。局部复发的中位时间为14个月。所有患者的2年局部无复发生存（LRFS）率为92.7%，5年为88.3%。所有局部复发患者在手术时年龄均<17岁。2例局部复发发生在肱骨近端，1例分别发生在跟骨、髋臼和股骨远端。辅助手术（高速磨钻、消融、骨替代材料和术前地诺单抗）均无助于降低局部复发风险（P>0.05）。在使用高速磨钻治疗的组和未使用骨替代材料治疗的组中，观察到局部复发减少的趋势。在使用骨替代材料治疗的组中，人工骨的LRFS率最佳，其次是同种异体骨和自体骨。在最后一次随访时，肌肉骨骼肿瘤学会平均评分为29.8（范围：25 - 30），表明术后功能结果良好。5例患者出现关节退变。局部复发患者的残疾程度和关节畸形程度较高（P<0.05）。2例患者接受了术前地诺单抗治疗，均未出现局部复发和功能障碍。
取得了良好的肿瘤学和功能结果。年龄<17岁与刮除术后局部复发风险高相关（P = 0.0198）。局部复发患者的功能结果较差。高速磨钻可能有助于降低复发风险。如果需要植骨，生物相容性低的材料，包括人工骨，可能是最佳选择。软骨母细胞瘤患者的管理应兼顾治疗和功能方面。
