肢体长骨骨巨细胞瘤个体化外科治疗的中长期临床结果分析

doi:10.3760/cma.j.cn101202-20200426-00147

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摘要目的对比个体化改良与常规方案治疗肢体长骨骨巨细胞瘤(GCTB)的临床效果,评估个体化改良方案的可行性。方法回顾性研究。纳入2005年1月—2017年12月内蒙古医科大学第二附属医院和天津医院两个骨肿瘤中心178例手术治疗的四肢长骨GCTB患者的临床资料,男95例、女83例,年龄8～75(35.7±11.7)岁。178例中,2005年1月—2011年12月70例患者设为常规组,其中男39例、女31例,年龄8～68岁,55例采用病灶内常规刮除加骨水泥、异体骨或自体骨填充,15例瘤段切除人工假体重建术;2012年1月—2017年12月108例患者设为改良组,其中男56例、女52例,年龄16～75岁,根据肿瘤发生的部位、Campanacci分级、病理骨折与否,采用95例改进的病灶内磨削术加骨水泥和或异体骨或自体骨填充,13例瘤段切除人工假体(膝关节为改进假体)重建等个体化改良方案。观察并对比两组术后并发症情况、术后复发转移情况及5年累积无复发生存率;末次随访时采用国际骨与软组织肿瘤协会(MSTS)评分标准比较术后两组患者肢体功能。结果 178例患者均顺利完成手术。两组基线资料比较差异均无统计学意义(P值均＞0.05)。所有患者术后随访24～117(56.9±26.1)个月。(1)术后有15例患者出现并发症,常规组11例(15.7%,11/70)、改良组4例(3.7%,4/108),常规组患者并发症发生率明显高于改良组,主要发生于瘤段切除关节重建患者,差异有统计学意义(χ²=7.939,P＜0.05)。(2)178例患者中,24例(13.5%)复发。常规组和改良组术后总体复发率分别为22.9%(16/70)和7.4%(8/108),差异有统计学意义(χ²=8.691, P＜0.05)。常规组中病灶内常规刮除术患者的复发率为27.3%(15/55),改良组中病灶内扩大刮除术患者的复发率为7.4%(7/95),差异有统计学意义(χ²=11.027,P＜0.05);两组瘤段切除重建术患者分别有1例复发,差异无统计学意义(P＞0.05)。患者的总复发率13.5%(24/178),其中桡骨远端和股骨近端复发5例(5/12)。178例患者5年总体累积无复发生存率为90.8%,其中常规组78.5%、改良组91.2%,两组比较差异有统计学意义(χ²=5.923, P＜0.05)。(3)178例患者术后肢体功能MSTS评分为(28.7±2.3)分,常规组和改良组分别为(27.61±3.13)分和(29.33±1.29)分,两组差异有统计学意义(t=4.365, P＜0.01)。两组患者中病灶内刮除的术后MSTS评分均较瘤段切除关节重建术高,差异均有统计学意义(t=5.620、2.177,P值均＜0.05)。结论采用个体化改良方案治疗后GCTB复发率较低,且患者肢体功能佳,瘤段切除联合改良假体重建可以改善肢体功能、降低术后并发症。

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	白锐
	赵振群
	刘艳成
	赵伟
	孙超
	冯卫
	薛慧琴
	王玉鑫
	胡永成
	郭世炳

关键词 ：骨巨细胞瘤, 复发, 临床结果, 肿瘤治疗方案, 肱骨, 股骨, 胫骨

Abstract：Objective To compare the effectiveness of individualized modified and conventional therapies in the treatment of the giant cell tumor of the long bone of extremities and evaluate the feasibility of the individualized modified regimen.Methods The clinical data of patients with long-bone giant cell tumour of bone(GCTB)of extremities treated by surgery in the Second Affiliated Hospital of Inner Mongolia Medical University and two bone tumor centers of Tianjin Hospital from January 2005 to December 2017 were included. A total of 95 males and 83 females aged 8-75(35.7±11.7) years were included. From January 2005 to December 2011, 70 cases (39 males and 31 females aged 8-68 years) were treated with routine curettage, bone cement, allogeneic bone or autogenous bone filling, and tumor segment resection and artificial prosthesis reconstruction, which were divided into routine group. From January 2012 to December 2017, according to the location of tumor, Campanacci grade, pathological fracture, modified intralesional grinding with bone cement and or allogeneic bone or autogenous bone filling, and tumor segment resection and artificial prosthesis (knee joint improved prosthesis) reconstruction were divided into individualized improved scheme group (improved group), 56 males and 52 females, aged 16-75 years. The observation indicators were as follows: postoperative complications, postoperative recurrence and metastasis and 5-year cumulative relapse-free survival rate between the two groups, and the International Musculoskeletal Tumor Society (MSTS) score at the last follow-up to compare the limb functions of the two groups after surgery.Results All patients completed the operation successfully. No significant difference was observed in the baseline data of the two groups (all P values＞0.05). All patients were followed up for 24-117(56.9±26.1) months. (1) In this study, there were 15 patients with postoperative complications, including 11 patients in the routine group (15.7%, 11/70) and 4 patients in the improved group (3.7%, 4/108), were observed. The incidence of complications in the routine group was significantly higher than that in the improved group and occurred in patients with segmental resection and joint reconstruction (χ²=7.939, P＜0.05). (2) Among 178 patients, 24 (13.5%) had recurrence. The postoperative recurrence rates in the conventional and the improved groups were 22.9% (16/70) and 7.4% (8/108), respectively, and the difference was statistically significant (χ²=8.691, P＜0.05). The recurrence rate of the conventional curettage was 27.3% (15/55) in the routine group and 7.4% (7/95) in the improved group. The difference between the two groups was statistically significant (χ²=11.027, P＜0.05). In the two groups, one patient had recurrence after resection and reconstruction (P＞0.05). The recurrence rate of the distal radius and the proximal femur in five cases (5/12), and the overall recurrence rate in both groups was 13.5%(24/178). The 5-year cumulative relapse-free survival rate of 178 patients was 90.8% (78.5%, routine group; 91.2%, improved group). The difference between the two groups was statistically significant (χ²=5.923, P＜0.05). (3) The MSTS score of the postoperative limb function in 178 patients was (28.7±2.3) points. The MSTS scores of the contrast ([27.61±3.13] points) and the improved ([29.33±1.29] points) groups were significantly different (t=4.365, P＜0.01). In both groups, the MSTS score after curettage was significantly higher than that after resection and reconstruction (t=5.620, 2.177, respectively; all P values＜0.05).Conclusions The giant cell tumor of bone patients treating with individualized modified therapies can receive low recurrence rate and improve postoperative function. The segmental resection combined with the modified prosthesis reconstruction can improve the joint function and reduce the postoperative complications.

Key words： Giant cell tumor of bone Recurrence Clinical outcome Antineoplastic protocols Humerus Femur Tibia

收稿日期: 2020-04-26

通讯作者: 郭世炳,Email:guoshibing2017@sina.com

引用本文:

白锐, 赵振群, 刘艳成, 赵伟, 孙超, 冯卫, 薛慧琴, 王玉鑫, 胡永成, 郭世炳. 肢体长骨骨巨细胞瘤个体化外科治疗的中长期临床结果分析[J]. 中华解剖与临床杂志, 2021, 26(3): 305-313.
Bai Rui, Zhao Zhenqun, Liu Yancheng, Zhao Wei, Sun Chao, Fen Wei, Xue Huiqin, Wang Yuxing, Hu Yongcheng, Guo Shibing. Long-term clinical results of surgical treatment in 178 cases of giant cell tumor of limb long bone. Chinese Journal of Anatomy and Clinics, 2021, 26(3): 305-313.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20200426-00147 或 http://www.cjac.com.cn/CN/Y2021/V26/I3/305

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