Wang Anqi, Hu Jinxin, Luo Tianqi, Tang Qinglian, Wang Jin, Zhu Xiaojun
From the Department of Musculoskeletal Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China.
J Am Acad Orthop Surg. 2025 Jul 24. doi: 10.5435/JAAOS-D-25-00217.
Campanacci grade III and recurrent giant cell tumors (GCTs) of the distal radius are aggressive, but treatments are scare, and universally accepted surgical strategy has not been established. The purpose of this study was to compare the clinical outcomes of different surgical methods for these tumors.
We retrospectively analyzed 26 patients with Campanacci grade III or recurrent GCT of the distal radius between 2017 and 2023 in this study. Patients were divided into intralesional curettage group (n = 12) and wide excision group (n = 14). According to the different reconstruction methods, the wide excision group was further divided into two subgroups, including the arthroplasty subgroup (n = 8) and the arthrodesis subgroup (n = 6). All patients underwentsurgeries, and perioperative denosumab was recommended. Pre- and postoperative active range of motion (ROM) of the wrist, grip strength, visual analog score, Mayo wrist score and Musculoskeletal Tumor Society score were assessed. Postoperative complications, denosumab application, and tumor recurrence were also evaluated.
The intralesional curettage group was superior to the wide excision group in reservation of ROM of the wrist but related to higher local recurrence rate (25% vs. 7.1%). Postoperative pain relief and satisfaction of the patients were more obvious in the wide excision group compared with the intralesional curettage group. Arthroplasty and arthrodesis following wide excision provided similar improvements in grip strength, visual analog score, Mayo wrist score, and Musculoskeletal Tumor Society scores after surgery. Arthroplasty better reserved ROM of the wrist but associated with more complications especially wrist instability and revision surgery than arthrodesis. Arthrodesis restricted flexion, extension, and radial and ulnar deviations of the wrist but related to few instability complications.
Wide excision was the preferred choice for Campanacci grade III and recurrent GCT of the distal radius considering adequate local control, good pain relief, and satisfaction. Extended intralesional curettage with postoperative denosumab administration was also a reasonable alternative with better functional outcomes but increased risk of recurrence and possibility of wide excision revision surgery in the future. Arthroplasty following wide excision could reserve the motion of wrist but associated with frequent wrist instability and relatively high revision surgery rate. Arthrodesis could ensure a more stable wrist, and it is recommended for manual workers.
Level III; Retrospective Cohort Comparison; Treatment Study.
桡骨远端的坎帕纳奇III级和复发性骨巨细胞瘤（GCTs）具有侵袭性，但治疗方法有限，尚未建立普遍接受的手术策略。本研究的目的是比较这些肿瘤不同手术方法的临床结果。
本研究回顾性分析了2017年至2023年间26例桡骨远端坎帕纳奇III级或复发性GCT患者。患者分为病灶内刮除组（n = 12）和广泛切除组（n = 14）。根据不同的重建方法，广泛切除组进一步分为两个亚组，包括关节成形术亚组（n = 8）和关节融合术亚组（n = 6）。所有患者均接受手术，并建议围手术期使用地诺单抗。评估术前和术后手腕的主动活动范围（ROM）、握力、视觉模拟评分、梅奥手腕评分和肌肉骨骼肿瘤学会评分。还评估了术后并发症、地诺单抗应用和肿瘤复发情况。
病灶内刮除组在保留手腕ROM方面优于广泛切除组，但局部复发率较高（25%对7.1%）。与病灶内刮除组相比，广泛切除组术后疼痛缓解和患者满意度更明显。广泛切除术后的关节成形术和关节融合术在术后握力、视觉模拟评分、梅奥手腕评分和肌肉骨骼肿瘤学会评分方面提供了相似的改善。关节成形术能更好地保留手腕的ROM，但与关节融合术相比，并发症更多，尤其是手腕不稳定和翻修手术。关节融合术限制了手腕的屈伸以及桡尺偏斜，但不稳定并发症较少。
考虑到足够的局部控制、良好的疼痛缓解和满意度，广泛切除是桡骨远端坎帕纳奇III级和复发性GCT的首选。术后使用地诺单抗的扩大病灶内刮除也是一种合理的选择，功能结果较好，但复发风险增加，未来可能需要进行广泛切除翻修手术。广泛切除术后的关节成形术可以保留手腕的活动，但与频繁的手腕不稳定和相对较高的翻修手术率相关。关节融合术可以确保手腕更稳定，建议体力劳动者采用。
III级；回顾性队列比较；治疗研究。
