徐明;许宋锋;惠文鹏;于秀淳;

• 1:济南军区总医院骨病科

摘要(Abstract)：

[目的]探讨采用病灶内肿瘤扩大刮除、骨水泥填充并钢板内固定联合二磷酸盐治疗邻膝关节骨巨细胞瘤的临床应用可行性。[方法]回顾分析2008年1月~2010年6月本科治疗的16例邻膝关节骨巨细胞瘤。男7例,女9例,平均年龄38岁(27~78岁)。发病部位:股骨远端10例,胫骨近端6例。所有患者术前均经仔细评估确定肿瘤腔的完整性,术中仔细刮除肿瘤组织,应用磨钻及电刀处理瘤腔壁,骨水泥填充修复骨缺损,同时给予钢板内固定。术后均应用二膦酸盐类药物。[结果]本组患者全部获得随访,中位随访15个月,无局部复发及转移发生。参照Ennek ing肢体功能评分标准,本组患者平均得29分(27~30)分。复查X线片示所有患者内固定均牢靠,无软骨下骨骨折。[结论]对于膝关节周围骨巨细胞瘤可以选择病灶扩大刮除、骨水泥充填内固定联合二膦酸盐类药物治疗,该方法具有操作简单、肢体功能恢复理想、近期复发率低、病人易于接受等优点。远期疗效有待进一步观察。

关键词(KeyWords)： 骨巨细胞瘤;扩大刮除术;骨水泥;骨接合术;二膦酸盐

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 徐明;许宋锋;惠文鹏;于秀淳;

Email:

DOI:

参考文献(References)：

• [1]Errani C,Ruggieri P,Asenzio MA,et al.Giant cell tumor of the ex-tremity:a review of 349 cases from a single institution[J].CancerTreat Rev,2010,36:1-7.
• [2]Enneking WF,Dunham W,Gebhardt MC,et al.A system for the func-tional evaluation of reconstructive procedures after surgical treatmentof tumors of the musculoskeletal system[J].Clin Orthop,1993,286:241-246.
• [3]乙军,施鑫,吴苏稼,等.不同术式治疗四肢大关节部位骨巨细胞瘤疗效分析[J].中国矫形外科杂志,2008,16:13-16.
• [4]Algawahmed H,Turcotte R,Farrokhyar F,et al.High-speed burringwith and without the use of surgical adjuvants in the intralesional man-agement of giant cell tumor of bone:a systematic review and meta-a-nalysis[J].Sarcoma,2010,2010:1-5.
• [5]Frassica FJ,Sim FH,Pritchard DJ,et al.Subchondral replacement:acomparative analysis of reconstruction with methyl methacrylate or au-togenous bone graft[J].Chir Organi Mov,1990,1:189-190.
• [6]Kivioja AH,Blomqvist C,Hietaniemi K,et al.Cement is recommendedin intralesional surgery of giant cell tumors:a Scandinavian SarcomaGroup study of 294 patients followed for a median time of 5 years[J].Acta Orthop,2008,79:86-93.
• [7]Kafchitsas K,Habermann B,Proschek D,et al.Functional results aftergiant cell tumor operation near knee joint and the cement radiolucentzone as indicator of recurrence[J].Anticancer Res,2010,30:3795-3799.
• [8]Fraquet N,Faizon G,Rosset P,et al.Long bones giant cells tumors:treatment by curretage and cavity filling cementation[J].OrthopTraumatol Surg Res,2009,95:402-406.
• [9]von Steyern FV,Kristiansson I,Jonsson K,et al.Giant-cell tumour ofthe knee.The condition of the cartilage after treatment by curettageand cementing[J].J Bone Joint Surg Br,2007,89:361-365.
• [10]杨正明,陶惠民,杨迪生,等.邻膝关节骨巨细胞瘤外科治疗的选择[J].中华外科杂志,2006,24:1693-1698.
• [11]吴莹光,马庆军,李晓光,等.阿仑膦酸钠抑制骨巨细胞瘤细胞生长和诱导其凋亡的研究[J].中国矫形外科杂志,2006,14:1500-1503.
• [12]Tse LF,Wong KC,Kumta SM,et al.Bisphosphonates reduce local re-currence in extremity giant cell tumor of bone:a case-control study[J].Bone,2008,42:68-73.