Abstract：Objective This study aims to explore the clinical efficacy of focus curettage combined with postoperative denosumab in the treatment of giant cell tumor of bone (GCT) in the femoral head and neck. Methods This is a retrospective study. The clinical data of six patients with GCT of femoral head and neck treated in the Department of Bone Tumor Surgery of the First Affiliated Hospital of Xinjiang Medical University from April 2013 to July 2019 were included three males and three females, aged 22-40 (28±6) years. The campanacci radiographic and imaging grades were all grade Ⅱ. Based on the GCT zoning method of proximal femur of bone tumor international limb salvage association: One case in the H1 region and five cases in the H1+H2 area. All six patients were treated with curettage, bone grafting, and internal fixation with a modified Watson-Jones approach. In addition, all of them were treated with denosumab injection regularly after the operation. Observation indicators: the time of operation, the amount of bleeding during the operation, the occurrence of short-term complications such as postoperative infection and osteonecrosis of the femoral head, the time of auxiliary walking after the operation, and monitor whether there were any adverse reactions during the treatment of denosumab; Regular imaging examination was performed to observe the survival of bone graft, bone destruction and resorption, osteogenesis at the edge of tumor cavity, displacement and fracture of internal fixation, and recurrence of GCT. Six months after the operation, the lower limb functions of patients were evaluated by the International Association of Bone Oncology (MSTS) functional reconstruction criteria for bone and soft tissue tumors. Results The operation was successfully performed on six patients, the average operation time was 179 min (15-215 min), and the intraoperative bleeding was 193-1 400 mL (mean 687 mL). There were no short-term complications found in the femoral head such as infection, fracture, and osteonecrosis. All six patients were followed up for 20-96 months (mean 48 months). The patient could carry weight on double crutches for 4-6 weeks, carry weight on crutches for 8-12 weeks, abandon crutches, and bear full weight 3-13 months after the operation. Six patients received subcutaneous injections of denosumab 6-18 times (average 12 times), and continued follow-up for 6-81 months (mean 37 months) after withdrawal. The X-ray films were reexamined regularly during the follow-up period, and the satisfactory time of tumor wall ossification was 6-15 months (mean 11 months). In addition, no abnormal blood calcium or phosphorus indexes, and no drug-related adverse events were found in the laboratory examination. There was no bone destruction, infection, fracture, internal fixation displacement, fracture, and other related complications, and no recurrence after the operation during the follow-up period. The MSTS score ranged from 26 to 30, with an average of 27, all six patients were excellent 6 months after the operation. Conclusion Focus curettage combined with postoperative denosumab in the treatment of GCT of the femoral head and neck can promote the ossification of the edge of the tumor cavity after the operation, and the effect is satisfactory.
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Chen Yang, Xiang Haibin, Akbar Yunus, Ya Dikan Yashengjiang. Clinical effect of focus curettage combined with denosumab in the treatment of giant cell tumor of the femoral head and neck. Chinese Journal of Anatomy and Clinics, 2022, 27(10): 691-696.
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2022, Vol. 27 
