CAJ | 학술논문

目的：探讨影响骨巨细胞瘤术后复发的危险因素。方法系统检索中国期刊全文数据库、中国生物医学文献数据库、PUBMED、EMBASE和MEDLINE数据库。经异质性检验后，对筛选出的与骨巨细胞瘤术后复发相关的危险因素：性别、年龄、部位、Jaffe分期、Companacci分级、Enneking分级、病理性骨折、手术方式及软组织受侵的OR进行合并，绘制漏斗图、计算失安全系数，判断是否存在发表偏倚，分析结果的稳定性。采用RevMan5．3版本软件进行荟萃分析。结果共纳入15篇文献进行分析，论证强度中等。年龄、肿瘤部位及手术方式与术后复发有关，合并OR（95％CI）分别为＜20岁组1．83（1．04～3．24） P ＝0．04、＞40岁组0．52（0．31～0．86） P ＝0．01，桡骨远端1．60（1．06～2．42）P＝0．02、肱骨近端0．35（0．14～0．90）P＝0．03，刮除3．64（1．88～7．04） P＝0．0001、刮除＋骨移植＋佐剂1．79（1．11～2．88） P＝0．02，刮除＋PMMA 0．56（0．35～0．91） P＝0．02、切除0．29（0．12～0．66） P＝0．003；而性别、肿瘤部位（股骨远端、股骨近端、胫骨远端、胫骨近端）、Jaffe分期、Companacci分级、Enneking分级、病理性骨折、软组织受侵刮除＋骨移植、刮除＋PMMA＋佐剂及切刮术与复发无明显关系，P＞0．05。结论本研究表明低龄（＜20岁）、桡骨远端及采取刮除术和刮除＋骨移植＋佐剂的骨巨细胞瘤患者术后复发率高，而高龄（＞40岁）、肱骨近端及采取切除术和刮除＋PMMA的骨巨细胞瘤患者术后复发率低。在治疗不同年龄组、不同部位的骨巨细胞瘤患者时，应同时兼顾功能恢复和术后复发，以提高治疗效果和患者的生存质量。
목적：탐토영향골거세포류술후복발적위험인소。방법계통검색중국기간전문수거고、중국생물의학문헌수거고、PUBMED、EMBASE화MEDLINE수거고。경이질성검험후，대사선출적여골거세포류술후복발상관적위험인소：성별、년령、부위、Jaffe분기、Companacci분급、Enneking분급、병이성골절、수술방식급연조직수침적OR진행합병，회제루두도、계산실안전계수，판단시부존재발표편의，분석결과적은정성。채용RevMan5．3판본연건진행회췌분석。결과공납입15편문헌진행분석，론증강도중등。년령、종류부위급수술방식여술후복발유관，합병OR（95％CI）분별위＜20세조1．83（1．04～3．24） P ＝0．04、＞40세조0．52（0．31～0．86） P ＝0．01，뇨골원단1．60（1．06～2．42）P＝0．02、굉골근단0．35（0．14～0．90）P＝0．03，괄제3．64（1．88～7．04） P＝0．0001、괄제＋골이식＋좌제1．79（1．11～2．88） P＝0．02，괄제＋PMMA 0．56（0．35～0．91） P＝0．02、절제0．29（0．12～0．66） P＝0．003；이성별、종류부위（고골원단、고골근단、경골원단、경골근단）、Jaffe분기、Companacci분급、Enneking분급、병이성골절、연조직수침괄제＋골이식、괄제＋PMMA＋좌제급절괄술여복발무명현관계，P＞0．05。결론본연구표명저령（＜20세）、뇨골원단급채취괄제술화괄제＋골이식＋좌제적골거세포류환자술후복발솔고，이고령（＞40세）、굉골근단급채취절제술화괄제＋PMMA적골거세포류환자술후복발솔저。재치료불동년령조、불동부위적골거세포류환자시，응동시겸고공능회복화술후복발，이제고치료효과화환자적생존질량。
Objective To explore the risk factors of giant cell tumor on extremities for patients with postoperative recurrence.Methods The literature reports published before June 2014 were searched in the electronic databases of CBM, CNKI, PUBNED, MEDLINE and EMBASE.Meta-analysis was performed by software Review Manager ( Version 5.3 ) .The odds ratios ( OR ) of gender, age, tumor site, Campanacci Classification, pathological fracture, selection of treatment and soft tissue invasion were analyzed with heterogeneity test.Publication bias were tested by funnel plot and fail-safe number.Sensitivity analysis was performed to assess the stability.Results A total of 15 case-control studies were identified.Age,location and type of surgery were associated with tumor recurrence.The combined OR(95%CI) was 1.83(1.04 -3.24) P=0.04 for aged <20 years,0.52(0.31 -0.86) P =0.01 for aged >40 years,1.60(1.06 -2.42) P=0.02 for distal radius,0.35(0.14-0.90) P=0.03 for proximal humerus,3.64 (1.88-7.04) P=0.0001 for curettage,0.56(0.35-0.91) P=0.02 for curettage with PMMA,1.79(1.11-2.88) P=0.02 for curettage with bone graft and adjuvant and 0.29 ( 0.12 -0.66 ) P =0.003 for resection respectively.There were not significant relationship between tumor recurrence and gender, tumor location ( distal femur,proximal femur,distal tibia,proximal tibia) ,Jaffe staging,Campanacci classification,Enneking classification, pathological fracture, soft tissue invasion, extensive curettage, curettage with bone graft, curettage with polymethylmethacrylate and adjuvant (P>0.05).Conclusion Youth (aged <20 years), distal radius,curettage and curettage with bone graft and adjuvant are the risk factors for recurrence of giant <br> cell tumor.However,advanced age (aged >40 years),proximal tibia,curettage with PMMA and resection appear to have lower risks for tumor recurrence.