CAJ | 학술논문

目的回顾性分析股骨近端骨巨细胞瘤的发病特点、治疗方法及疗效,探讨不同手术方式的适应证及注意事项,分析复发及影响肢体功能的危险因素.方法收集1991年11月至2012年6月全国4个骨肿瘤治疗中心临床资料完整的43例股骨近端骨巨细胞瘤患者的病例资料,将其中初次治疗、随访时间超过2年的28例患者纳入研究,男19例,女9例;首诊时平均年龄(28.7±8.8)岁.按照骨肿瘤国际保肢协会(International Society of Limb Salvage,ISOLS)股骨近端的分区方法,H1区2例,H2区20例,H1+H2区6例.Campanacci分级Ⅱ级22例、Ⅲ级6例,其中7例合并病理性骨折.初次手术采用扩大刮除术21例,整块切除重建术7例.分析影响手术方式选择、复发及肢体功能的因素,包括发病部位、Campanacci分级、病理性骨折及手术方式.结果全部患者术后均得到随访,随访时间25～273个月,平均(69.8±50.3)个月.行刮除术的21例患者中2例(9.5％)局部复发,行整块切除的7例患者均无复发.病理性骨折及Campanacci分级是影响手术方式选择的因素.手术方式、病理性骨折、Campanacci分级与患者的局部复发率无相关性.采用刮除重建的患者术后功能优于行整块切除重建者.结论股骨近端骨巨细胞瘤主要侵犯股骨颈及转子部,与膝关节周围骨巨细胞瘤相比发生病理性骨折的风险高.整块切除重建术的适应证为合并病理性骨折或CampanacciⅢ级的患者.通过不同手术入路充分显露、刮除病灶,合理的预防性内固定可以降低刮除术后的复发率和并发症.
목적 회고성분석고골근단골거세포류적발병특점、치료방법급료효,탐토불동수술방식적괄응증급주의사항,분석복발급영향지체공능적위험인소.방법 수집1991년11월지2012년6월전국4개골종류치료중심림상자료완정적43례고골근단골거세포류환자적병례자료,장기중초차치료、수방시간초과2년적28례환자납입연구,남19례,녀9례;수진시평균년령(28.7±8.8)세.안조골종류국제보지협회(International Society of Limb Salvage,ISOLS)고골근단적분구방법,H1구2례,H2구20례,H1+H2구6례.Campanacci분급Ⅱ급22례、Ⅲ급6례,기중7례합병병이성골절.초차수술채용확대괄제술21례,정괴절제중건술7례.분석영향수술방식선택、복발급지체공능적인소,포괄발병부위、Campanacci분급、병이성골절급수술방식.결과 전부환자술후균득도수방,수방시간25～273개월,평균(69.8±50.3)개월.행괄제술적21례환자중2례(9.5％)국부복발,행정괴절제적7례환자균무복발.병이성골절급Campanacci분급시영향수술방식선택적인소.수술방식、병이성골절、Campanacci분급여환자적국부복발솔무상관성.채용괄제중건적환자술후공능우우행정괴절제중건자.결론 고골근단골거세포류주요침범고골경급전자부,여슬관절주위골거세포류상비발생병이성골절적풍험고.정괴절제중건술적괄응증위합병병이성골절혹CampanacciⅢ급적환자.통과불동수술입로충분현로、괄제병조,합리적예방성내고정가이강저괄제술후적복발솔화병발증.
Objective To retrospective analysis the onset characteristics and outcome of surgical management in patients with giant cell tumor (GCT) of proximal femur,explore the operation indication and the risk factors for recurrence and limb function.Methods From November 1991 to June 2012,43 patients with GCT in the proximal femur from domestic four bone tumor centers were involved,among which 28 patients were enrolled in this study,including 19 males and 9 females,with an average age of (28.7±8.8) years.According to International Society of Limb Salvage (ISOLS),there were 2 cases in H1,20 cases in H2,and 6 cases both in H1 and H2.There were 22 cases of Campanacci Ⅱ,6 cases of Campanacci Ⅲ,and 7 cases with pathologic fracture.The primary surgical treatment included extensive curettage in 21 cases and resection in 7 cases.The risk factors affecting selection of surgical manners,tumor recurrence,and functional outcomes were analyzed.Results All patients were followed up with a mean duration of (69.8±50.3) months,ranging from 25 to 273 months.The local recurrence rate was 9.5％ for patients treated with intralesional curettage,0％ for marginal excision.Pathological fracture,Campanacci grades had a significant influence on the selection of surgical manners.Types of surgery,pathological fracture,Campanacci grades were not the risk factors for recurrence.The postoperative function of curettage group was better than the marginal excision group.Conclusion GCT of proximal femur are most commonly seen in femoral neck and intertrochanteric part,whose fracture risk is high.Patients with pathological fracture or Campanacci grade Ⅲ need en bloc resection and reconstruction.Fully revealed lesions,extensive curettage and reasonable preventive application of internal fixation could improve the success rate of intralesional curettage.