摘要
目的探讨扩大刮除术治疗软骨母细胞瘤的疗效。方法回顾性分析2011年1月—2016年5月,采用病灶扩大刮除术治疗的37例软骨母细胞瘤患者临床资料。男24例,女13例;年龄12~30岁,中位年龄17岁。原发患者32例,复发患者5例。患者均以局部疼痛为首发症状。病程2~8个月,平均4.9个月。病变部位:股骨远端10例,股骨近端7例,胫骨近端9例,肱骨近端5例,髌骨2例,距骨1例,跟骨1例,骨盆2例。根据良性骨肿瘤的Enneking分期均为3期。病灶长径为1.2~6.9 cm,平均3.2 cm。19例病变累及骺板。结果术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间12~76个月,平均40.5个月。末次随访时国际肌肉骨骼肿瘤学会(MSTS)评分为(27.5±1.4)分,与术前(18.5±1.9)分比较,差异有统计学意义(t=23.462,P=0.000)。术后5个月复发1例(2.7%)。X线片复查示,6例出现部分植骨吸收,但植骨区关节面未见明显塌陷。3例骺板受累且病变位于膝关节周围者,出现肢体短缩畸形,但无内外翻畸形,膝关节活动未受影响。结论扩大刮除术治疗软骨母细胞瘤具有术后复发率低、肢体功能良好、骨骼发育畸形发生率低等优点,是治疗该疾病较好方法。
Objective To explore the effectiveness of expanded curettage in the treatment of chondroblastoma.Methods The clinical data of 37 patients with chondroblastoma who were treated with expanded curettage between January 2011 and May 2016 were retrospectively analyzed. There were 24 males and 13 females, with a median age of 17 years(range, 12-30 years). There were 32 primary patients and 5 recurrent patients. Local pain was the first symptom in all patients. The average disease duration was 4.9 months(range, 2-8 months). The lesions were located in the distal femur in 10 cases, the proximal femur in 7 cases, the proximal tibia in 9 cases, the proximal humerus in 5 cases, the patella in2 cases, the talus in 1 case, the calcaneus in 1 case, and pelvis in 2 cases. According to the Enneking staging of benign bone tumors, all tumors were rated as the 3 rd stage. The length of the lesion ranged from 1.2 to 6.9 cm(mean, 3.2 cm). The lesions involved the epiphyseal plate in 19 cases. Results All incisions healed by first intention, and no complications occurred. All patients were followed up 12-76 months, with an average of 40.5 months. At last follow-up, the Musculoskeletal Tumor Society(MSTS) score was 27.5±1.4, and the difference was significant when compared with preoperative value(18.5±1.9)(t=23.462, P=0.000). The chondroblastoma recurred in 1 case(2.7%) after 5 months. X-ray film showed that bone resorption was found in 6 cases, but there was no obvious collapse in the articular surface of bone graft. The limb shortening deformity occurred in 3 cases who were epiphyseal plate involvement patients and lesions located around the knee joint. But there was no varus deformity, and knee joint activity was not affected.Conclusion Expanded curettage has advantages of low incidence of recurrence and skeletal deformity, good limb function, and it is one of the ideal options for chondroblastoma.
引文
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