扩大刮除植骨与瘤段切除重建治疗股骨近端骨巨细胞瘤的疗效分析

doi:10.3760/cma.j.issn.2095-7041.2019.03.007

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摘要目的比较扩大刮除植骨与瘤段切除重建两种术式治疗股骨近端骨巨细胞瘤患者的临床效果,分析影响下肢运动功能的康复、围手术期并发症及肿瘤复发的因素。方法回顾性分析中国医科大学肿瘤医院2013年1月—2017年12月收治的35例股骨近端骨巨细胞瘤患者的临床资料,其中男18例、女17例,确诊年龄为(39.85±11.59)岁。根据肿瘤发病部位及影像学分型,结合骨巨细胞瘤中国协作组成员单位(GTOC)评分,分别对患者采用扩大刮除植骨(15例)或瘤段切除重建治疗(20例)。术后定期随访,比较两种术式的手术时间、术中出血量、术后辅助行走时间、短期并发症及末次随访下肢功能国际骨与软组织肿瘤协会(MSTS)评分、肿瘤复发情况。对比分析病理性骨折、骨肿瘤国际保肢协会(ISOLS)股骨近端肿瘤分区、Campanacci分级、手术方式及肿瘤体积,对患者肿瘤转归及下肢功能恢复情况的影响。结果全部患者术后随访4~60(33.50±16.65)个月,2例患者分别于术后6个月和8个月死于其他原发肿瘤转移恶化,1例术后6个月意外死亡。末次随访时,术前合并病理性骨折的患者术后下肢功能MSTS评分为(20.00±3.33)分,低于未合并病理性骨折患者的(22.88±3.81)分,差异有统计学意义(t=2.381, P＜0.05)。扩大刮除植骨术中出血量(316.55±80.35)mL,低于瘤段切除重建术的(384.53±76.37)mL,差异有统计学意义(t=2.530, P＜0.05);扩大刮除植骨术后短期并发症2例,瘤段切除重建术后8例,两者相比差异有统计学意义(χ²=7.887, P＜0.05)。手术方式、是否存在病理性骨折、ISOLS分区、肿瘤体积及Campanacci分级对肿瘤复发情况的影响无组间差异(P值均＞0.05)。结论扩大刮除植骨与瘤段切除重建两种术式治疗股骨近端骨巨细胞瘤可获得相似的下肢功能恢复效果,肿瘤复发率亦无差异;但瘤段切除重建手术创伤较大,术中出血量及术后短期并发症发生率较高。术前发生病理性骨折,对患者术后下肢功能恢复产生负面影响。

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关键词 ：股骨肿瘤, 骨巨细胞瘤, 扩大刮除植骨, 瘤段切除重建, 股骨近端

Abstract：Objective To compare the clinical outcome of aggressive curettage with bone grafting and bone tumor resection with reconstruction of patients with proximal femoral giant cell tumor, and to analyzed the factors affecting rehabilitation of lower limb motor function, perioperative complications and tumor recurrence.Methods A retrospective analysis of 35 patients with giant cell tumor of the proximal femur was conducted in the Affiliated Tumor Hospital of China Medical University from January 2013 to December 2017.There were 18 male patients and 17 female patients, the average age was (39.85±11.59) years. According to the patient's tumor location, imaging classification and Giant Cell Tumor Team of China(GTOC) scores, patients received the treatment of aggressive curettage with bone grafting(15 patients) or bone tumor resection with reconstruction(20 patients). The patients received postoperative follow-up regularly. The duration of surgery, intraoperative blood loss, postoperative assisted walking time, short-term complications, Musculoskeletal Tumor Society(MSTS) scores of lower limb function and tumor recurrence were compared between the two procedures. The effects of pathological fracture, International Society of Limb Salvage(ISOLS) proximal tumor segmentation, Campanacci classification, surgical procedure and tumor volume on tumor relapse and lower limb function recovery were compared.Results All patients were followed up for 4-60(33.50±16.65) months. Two patients died of tumor metastasis at 6 and 8 months after surgery, and one patient died unexpectedly 6 months postoperative. The MSTS scores of lower limb function in patients with pathological fractures were 20.00±3.33, and in patients without pathological fractures were (22.88±3.81), there was significant different in statistics analysis (t=2.381, P＜0.05). However, the amount of intraoperative blood loss [(316.55±80.35)mL vs.(384.53±76.37)mL] and short-term complications(2 vs. 8) were significantly higher in bone tumor resection and reconstruction group than in aggressive curettage with bone grafting group (t=2.530, χ²=7.887, P＜0.05). There were no differences in the effects of surgical methods, presence of preoperative pathological fractures, ISOLS division, tumor volume, and Campanacci classification in tumor recurrence and lower limb function scores(all P values＞0.05).Conclusions Aggressive curettage with bone grafting and bone tumor resection with reconstruction can achieve similar lower limbs functional recovery and the same level of tumor recurrence rate.Due to the larger orientation of the tumor resection and reconstruction, the intraoperative blood loss and short-term complications was higher. Preoperative pathological fractures had a negative impact on the recovery of postoperative lower limb function.

Key words： Femoral neoplasms Giant cell tumor of bone Tumor resection with reconstruction Reconstruction of tumor segment Proximal femur

收稿日期: 2018-09-28

通讯作者: 张晓晶,Email: xiaaojingzhang@hotmail.com

引用本文:

李盛龙, 陈朋, 郑珂, 王巍, 裴祎, 张晓晶. 扩大刮除植骨与瘤段切除重建治疗股骨近端骨巨细胞瘤的疗效分析[J]. 中华解剖与临床杂志, 2019, 24(3): 232-237.
Li Shenglong, Chen Peng, Zheng Ke, Wang Wei, Pei Yi, Zhang Xiaojing. Clinical analysis of aggressive curettage with bone grafting and tumor resection with reconstruction for giant cell tumor of proximal femur. Chinese Journal of Anatomy and Clinics, 2019, 24(3): 232-237.

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http://www.cjac.com.cn/CN/10.3760/cma.j.issn.2095-7041.2019.03.007 或 http://www.cjac.com.cn/CN/Y2019/V24/I3/232

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