复发性骨巨细胞瘤手术治疗.docVIP

复发性骨巨细胞瘤手术治疗 　【摘要】 目的探讨复发性骨巨细胞瘤的手术治疗选择。方法回顾我院近3年收治的复发性骨巨细胞瘤23例，分析术后复发情况，评价关节功能。结果本组病例中，7例行再次病灶刮除植骨，13例行瘤段切除，3例行截肢。平均随访26.5个月，21例无复发，1例复发伴肺转移，1例死亡。瘤段切除病例中，10例行人工关节置换，2例行异体骨移植。对病灶刮除组、关节置换组和异体骨移植组进行Enneking功能评分，分别为29.8、25.2和22分。病灶刮除组和异体骨移植组差异有统计学意义（Plt;0.05）。结论复发性骨巨细胞瘤首选病灶刮除。如存在病灶刮除反指征，则膝关节周围选择瘤段切除人工关节置换，腕关节周围选择带关节异体骨移植或同时合并关节融合。骨盆部位复发病例首选瘤段切除。 【关键词】 骨巨细胞瘤；复发；手术 　　Surgical Treatment of Recurrent Giant Cell Tumors of Bone 　　Abstract：ObjectiveTo evaluate different choices of the surgical approach to recurrent giant cell tumors of bone.MethodsIn the recent 3 years,23 cases of recurrent giant cell tumor were overviewed retropectively.The recurrence rate and the function of adjiacent joint were analyzed.ResultsIn this series,7 cases had curettage,13 cases had wide resection and 3 cases had amputation.All patients had been followed up for a meantime of 26.5 months.There were only 1 case of recurrence with lung metatasis and 1 case of death.In the wide resection group,10 cases were reconstruced with prosthetic replacement,and 2 cases with allograft.The enneking functional score of curettage group,prosthetic replacement group and allograft group were 29.8,25.2 and 22 respectively.There had statistically difference between curettage group and allograft group (Plt;0.05).ConclusionIn recurrent giant cell tumors of bone,curettage method was recommended firstly.If there had any antiindex of curretage,lesions around the knee should be treated with wide resection and prosthetic replacement,and lesions around the wrist should be treated with wide resection and allograft with or without arthrodesis.Lesions located in the pelvis and sacrum should be treated with wide resection. 　　Key words：Giant cell tumor of bone;Recurrence;Surgery 　　0引言 　　骨巨细胞瘤具潜在恶性，在亚洲人群中高发[1]。单纯病灶刮除术后复发率较高，在16%~25%左右[24]。复发病例的再度复发率是初发病例的2~3.5倍[3,4]。同时，骨巨细胞瘤有原发或继发恶性可能[5,6]。因此，对复发性巨细胞瘤治疗方案选择存在困难和争议。本文拟回顾我院近3年收治的复发性巨细胞瘤病例，并结合国内外研究近况，探讨骨巨细胞瘤复发后再次手术的治疗方向。 　　1资料与方法 　　1.1临床资料本文收集我院自2003年5月~2006年2月收治的复发性骨巨细胞瘤病例23例，其中男性13