Malina Mário, Majerčík Matej, Naser Yousef
I. ortopedicko-traumatologicka klinika Lekarskej fakulty Univerzity Komenskeho a Univerzitnej nemocnice Bratislava.
Klinika ortopedie a traumatologie pohyboveho ustrojenstva Univerzitnej nemocnice L. Pasteura Kosice.
Acta Chir Orthop Traumatol Cech. 2025 Mar;92(1):52-57. doi: 10.55095/achot2024/068.
Early surgical treatment of giant cell tumour of the bone has very good functional outcomes with a relatively low risk of local recurrence and metastatic spread.In case of a pathologic fracture, extraosseous extension, and tumor location in an anatomically difficult area, surgical treatment may represent a big challenge with an uncertain functional outcome.Our case report presents a 35-year-old patient with a delayed diagnosis of giant cell tumor of the proximal radius of the dominant limb, with pulmonary metastases. Following neoadjuvant Denosumab therapy, with a major treatment effect on both the primary tumor and pulmonary metastases, we performed a wide resection and combined biological reconstruction with fibular autograft, radial head endoprosthesis, and comprehensive elbow ligament reconstruction.At 24 months after surgery, the patient is self-sufficient, capable of more physically demanding work, with a satisfactory functional outcome of reconstruction (MSTS 66.6%, TESS 69%), with no signs of local recurrence and regression of pulmonary metastases at 18 months after the last administration of Denosumab.
骨巨细胞瘤的早期手术治疗具有非常好的功能预后，局部复发和转移扩散风险相对较低。对于病理性骨折、骨外扩展以及肿瘤位于解剖结构复杂区域的情况，手术治疗可能是一项巨大挑战，功能预后不确定。我们的病例报告介绍了一名35岁患者，其优势上肢近端桡骨骨巨细胞瘤诊断延迟，伴有肺转移。在接受新辅助地诺单抗治疗后，对原发性肿瘤和肺转移均产生了显著治疗效果，我们进行了广泛切除，并采用腓骨自体移植、桡骨头假体置换及全面的肘部韧带重建进行联合生物重建。术后24个月，患者生活自理，能够从事体力要求更高的工作，重建功能预后令人满意（肌肉骨骼肿瘤协会评分66.6%，上肢肘关节功能评分69%），在最后一次给予地诺单抗后18个月，无局部复发迹象，肺转移灶也未进展。
