CAJ | 학술논문

目的：研究手术治疗膝关节周围骨巨细胞瘤的肢体功能、局部复发及术后并发症情况，并探讨不同类型膝关节周围骨巨细胞瘤的合理术式。方法回顾性分析2007年1月－2010年1月间入院诊治的96例膝关节周围骨巨细胞瘤患者的临床资料，治疗后均随访3年，评价患者的肢体功能和关节功能，总结患者的术式、术后复发情况、术后并发症。对术后复发危险因素及影响肢体功能的因素进行单因素分析。结果关节功能优良率囊内切除术组为76．79％，切刮除组为87．50％，边缘刮除组为81．25％，囊内切除术组显著低于后两组（P＜0．05）；肢体功能优良率囊内切除术组为76．78％，切刮除术组为75．00％，边缘切除术组为78．13％，3组差异不显著（P＞0．05）。在随访3年内，共12例复发，复发率为12．50％。随访期间，未见神经血管损伤，囊内切除术与切刮除术未见术后并发症，边缘切除术出现7例假体并发症。影响肢体功能的因素有首诊原发/复发、Enneking分期、软组织肿块及术式（P＜0．05）；而术后复发危险因素只与术式有关（ P＜0．05）。结论囊内切除、切刮除、边缘刮除对膝关节周围骨巨细胞瘤的治疗各有利弊，且术式的选择对术后复发及肢体功能均有一定的影响；要求临床医师结合患者年龄、肿瘤分级分期等综合选择术式。
목적：연구수술치료슬관절주위골거세포류적지체공능、국부복발급술후병발증정황，병탐토불동류형슬관절주위골거세포류적합리술식。방법회고성분석2007년1월－2010년1월간입원진치적96례슬관절주위골거세포류환자적림상자료，치료후균수방3년，평개환자적지체공능화관절공능，총결환자적술식、술후복발정황、술후병발증。대술후복발위험인소급영향지체공능적인소진행단인소분석。결과관절공능우량솔낭내절제술조위76．79％，절괄제조위87．50％，변연괄제조위81．25％，낭내절제술조현저저우후량조（P＜0．05）；지체공능우량솔낭내절제술조위76．78％，절괄제술조위75．00％，변연절제술조위78．13％，3조차이불현저（P＞0．05）。재수방3년내，공12례복발，복발솔위12．50％。수방기간，미견신경혈관손상，낭내절제술여절괄제술미견술후병발증，변연절제술출현7례가체병발증。영향지체공능적인소유수진원발/복발、Enneking분기、연조직종괴급술식（P＜0．05）；이술후복발위험인소지여술식유관（ P＜0．05）。결론낭내절제、절괄제、변연괄제대슬관절주위골거세포류적치료각유리폐，차술식적선택대술후복발급지체공능균유일정적영향；요구림상의사결합환자년령、종류분급분기등종합선택술식。
Objective To study limb function ,local recurrence and postoperative complications of surgery for giant cell tumor of bone around the knee ,and explore reasonable surgical procedures in different types of giant cell tumor of bone around the knee .Methods Clinical data of 96 cases of giant cell tumor of bone around the knee were retrospectively analyzed ,limb function and joint function,surgical treatment,postoperative recurrence,postoperative complications were followed up for 3 years.Factors affecting recurrence and risk factors of physical function were studied by univariate analysis .Results Excellent rates of joint function in intracapsular resection group ,cut curettage group and margin resection group were 76.79%,87.50% and 81.25%, intracapsular resection group was significantly lower than that of the other 2 groups (P<0.05);excellent rates of limb function in intracapsular resection group ,cut curettage group and margin resection group were 76.78%,75.00%and 78.13%,the 3 groups had no significant difference (P>0.05).In the follow-up of 3 years,there were 12 cases of recurrence,the recurrence rate was 12.50%.During follow-up,there had no neurovascular injury ,intracapsular resection group and cut curettage group had no com-plications ,margin resection group had 7 implant complications .Factors affecting limb function were first diagnosed with primary /recurrence,Enneking staging,and surgical soft tissue mass (P<0.05);while the only risk factor for recurrence was surgical re-lated (P<0.05).Conclusion Intracapsular resection,cut curettage and margin resection for giant cell tumor of bone around the knee has advantages and disadvantages ,and the choice of surgical recurrence and limb function has a certain role;age,tumor grading and staging and other comprehensive selection of surgical procedures need to be considered .