Gupta Gagandeep, Singh Abhishek, Kala Shivang, Saini Akhilesh, Singh Shristi, Shende Sopan
Department of Orthopaedics, Maharishi Markandeshwar Institute of Medical Sciences and Research, Ambala, Haryana, India.
J Orthop Case Rep. 2025 Jun;15(6):113-118. doi: 10.13107/jocr.2025.v15.i06.5684.
Giant cell tumor (GCT) of bone is a locally aggressive, benign neoplasm, accounting for approximately 20% of all bone tumors. While the distal femur and proximal tibia are the most common locations for GCTs, with the majority arising in the epiphyseal regions, their occurrence in the proximal femur is relatively rare, representing only 5.5% of cases. These tumors pose significant management challenges due to their tendency to cause pathological fractures, aggressive local behavior, and involvement of critical weight-bearing bones. Effective treatment requires careful consideration of both oncological control and functional preservation.
A 43-year-old male presented with a GCT in the proximal femur, complicated by a pathological fracture of the femoral neck. Given the tumor's size and location, the patient underwent extended curettage (EC) to remove the tumor, followed by internal fixation with a dynamic hip screw and the application of bone cement for additional stabilization. Post-operative monitoring, including clinical and radiological assessments, showed favorable results. After a 12-month follow-up period, the patient had no signs of recurrence, and his functional and radiological outcomes were excellent, with restored mobility and the ability to bear weight on the affected limb.
This case emphasizes the need for a tailored treatment strategy when managing GCTs of the proximal femur, particularly in resource-limited settings. The combination of EC, internal fixation, and bone cement was effective in achieving both oncological control and functional recovery. Long-term follow-up remains essential to monitor for recurrence and to ensure the integrity of the fixation device. The positive outcomes in this case highlight the potential for successful management of GCTs in challenging anatomical locations with appropriate surgical intervention and post-operative care.
骨巨细胞瘤（GCT）是一种具有局部侵袭性的良性肿瘤，约占所有骨肿瘤的20%。虽然股骨远端和胫骨近端是GCT最常见的发病部位，大多数发生在骨骺区域，但它们在股骨近端的发生相对罕见，仅占病例的5.5%。由于这些肿瘤容易导致病理性骨折、具有侵袭性的局部行为以及累及关键的负重骨，因此在治疗上带来了重大挑战。有效的治疗需要仔细权衡肿瘤控制和功能保留。
一名43岁男性因股骨近端骨巨细胞瘤就诊，并发股骨颈病理性骨折。鉴于肿瘤的大小和位置，患者接受了扩大刮除术（EC）以切除肿瘤，随后使用动力髋螺钉进行内固定，并应用骨水泥以增强稳定性。术后监测，包括临床和影像学评估，结果良好。经过12个月的随访期，患者没有复发迹象，其功能和影像学结果极佳，患侧肢体恢复了活动能力并能够负重。
该病例强调了在处理股骨近端骨巨细胞瘤时，尤其是在资源有限的情况下，需要制定个性化的治疗策略。扩大刮除术、内固定和骨水泥的联合应用在实现肿瘤控制和功能恢复方面是有效的。长期随访对于监测复发和确保固定装置的完整性仍然至关重要。该病例的积极结果凸显了在具有挑战性的解剖部位通过适当的手术干预和术后护理成功治疗骨巨细胞瘤的潜力。
