扩大刮除并骨水泥填充治疗骨巨细胞瘤的临床诊疗分析
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摘要
目的探讨骨巨细胞瘤行扩大刮除并骨水泥填充治疗的临床效果,以期进一步指导临床诊疗。方法回顾性分析2010年9月至2016年4月在我院行扩大刮除并骨水泥填充术式治疗的骨巨细胞瘤(giant cell tumor ofbone,GCT)患者64例,男性28例,女性36例;年龄16～59岁,平均31.6岁。肿瘤部位:股骨远端26例,胫骨近端17例,股骨近端8例,肱骨近端10例,距骨2例,跟骨1例。肿瘤影像学分级按Campanacci分级标准,其中Ⅰ级患者20例,Ⅱ级患者29例,Ⅲ级患者15例。将患者的性别、年龄、肿瘤生长部位、Campanacci分级、骨与软组织肿瘤协会(musculoskeletal tumor society,MSTS)评分、有无病理性骨折、有无软组织肿块、肿瘤大小(长径)与肿瘤复发进行单因素分析;多因素分析采用Logistic回归分析;不同影像学分级与肿瘤复发相关性采用χ2检验。结果 64例患者均获得随访,随访时间12～74个月,平均42.8个月。64例患者中肿瘤复发8例,复发率为12.5%,术后无远处转移及恶变者。术后肢体功能评价数值为(27.06±1.45)分;多因素Logistic回归分析,结果显示只有Campanacci分级是影响复发的关键因素(回归系数2.368,P=0.04)。经χ2检验分析,CampanacciⅠ级与Ⅱ级、Ⅰ级与Ⅲ级术后复发率P值分别为0.007、0.002,差异有统计学意义(P<0.05),CampanacciⅡ级与Ⅲ级的P值为0.23,差异无统计学意义(P>0.05)。本组病例术后长期随访均未出现关节面塌陷、骨折等相关并发症,关节活动度良好,行走功能均较为满意。结论扩大刮除并骨水泥填充是治疗GCT的一种可靠治疗方式,术后整体复发率相对较低,肢体功能恢复较为满意;Campanacci分级是影响其复发的关键因素。
Objective To explore the clinical effect of expand curettage and bone cement filling in(giant cell tumor of bone,GCT)treatment,in order to further guide clinical diagnosis and treatment.Methods We retrospective analyzed64 cases of GCT patients treated by expanded curettage and bone cement filling in our hospital,including 28 males and36 females with a mean age of 31.6 years(range,16～59 y).Tumors were located in distal femur in 26 cases,proximal tibia in 17 cases,proximal femur in 8 cases,proximal humerus in 10 cases,talus in 2 cases and calcaneus in 1 case.Tumor image was graded according to the Campanacci classification criteria.There were 20 patients with grade I,29 patients with gradeⅡ,and 15 patients with gradeⅢ.Eight clinical factors were analyzed by single factor analysis,such as gender,age,location of tumor,Campanacci classification,MSTS score,whether having apathological fracture,Whether having a soft tissue mass,tumor size and tumor recurrence.Logistic regression analysis was used in multi-factor analysis,and the correlation between Campanacci grades and tumor recurrence was analyzed byχ2 analysis.Results All 64 patients were followed up for 12 to 74 months,with an average of 42.8 months.Eight of 64 cases recurred with recurrence rate was12.5%.There was no distant metastasis and malignant transformation after operation.The postoperative evaluation of limb function was(27.06±1.45).The results of multivariate logistic regression model indicated that Campanacci grades was a key factor affecting tumor recurrence(regression coefficien t=2.368,P=0.04).The P values of recurrence rates were 0.007 and 0.002 for Campanacci grade I and gradeⅡ,as well as grade I and gradeⅢ,respectively after the analysis ofχ2 test,suggesting a statistical significance in their difference(P<0.05).The P value of CampanacciⅡ andⅢ was 0.23,which did not show any statistical significance(P>0.05).There were no complications such as articular surface collapse and fracture in the long-term follow-up group after operation.Instead,the joint mobility was good and walking function was satisfactory.Conclusion Expanded curettage and bone cement filling treatment is a reliable treatment for GCT,The overall recurrence rate is relatively low and the recovery of limb function is satisfactory.The Campanacci grades is the key factor that affects the recurrence.
Objective To explore the clinical effect of expand curettage and bone cement filling in(giant cell tumor of bone,GCT)treatment,in order to further guide clinical diagnosis and treatment.Methods We retrospective analyzed64 cases of GCT patients treated by expanded curettage and bone cement filling in our hospital,including 28 males and36 females with a mean age of 31.6 years(range,16～59 y).Tumors were located in distal femur in 26 cases,proximal tibia in 17 cases,proximal femur in 8 cases,proximal humerus in 10 cases,talus in 2 cases and calcaneus in 1 case.Tumor image was graded according to the Campanacci classification criteria.There were 20 patients with grade I,29 patients with gradeⅡ,and 15 patients with gradeⅢ.Eight clinical factors were analyzed by single factor analysis,such as gender,age,location of tumor,Campanacci classification,MSTS score,whether having apathological fracture,Whether having a soft tissue mass,tumor size and tumor recurrence.Logistic regression analysis was used in multi-factor analysis,and the correlation between Campanacci grades and tumor recurrence was analyzed byχ2 analysis.Results All 64 patients were followed up for 12 to 74 months,with an average of 42.8 months.Eight of 64 cases recurred with recurrence rate was12.5%.There was no distant metastasis and malignant transformation after operation.The postoperative evaluation of limb function was(27.06±1.45).The results of multivariate logistic regression model indicated that Campanacci grades was a key factor affecting tumor recurrence(regression coefficien t=2.368,P=0.04).The P values of recurrence rates were 0.007 and 0.002 for Campanacci grade I and gradeⅡ,as well as grade I and gradeⅢ,respectively after the analysis ofχ2 test,suggesting a statistical significance in their difference(P<0.05).The P value of CampanacciⅡ andⅢ was 0.23,which did not show any statistical significance(P>0.05).There were no complications such as articular surface collapse and fracture in the long-term follow-up group after operation.Instead,the joint mobility was good and walking function was satisfactory.Conclusion Expanded curettage and bone cement filling treatment is a reliable treatment for GCT,The overall recurrence rate is relatively low and the recovery of limb function is satisfactory.The Campanacci grades is the key factor that affects the recurrence.
引文
[1] Sung HW,Kuo DP,Shu WP,et al.Giant-cell tumorof bone:analysis of two hundred and eight cases inChinese patients[J].J Bone Joint Surg(Am),1982,64(5):755-761.
[2] Niu X,Zhang Q,Hao L,et al.Giant cell tumor of theextremity:retrospective analysis of 621Chinese pa-tients from one institution[J].J Bone Joint Surg(Am),2012,94(5):461-467.
[3] Jaffe HL.Giant cell tumor of bone:problems of dif-ferential diagnosis:1944[J].Bull Hosp Jt Dis,1995,54(2):109-112.
[4] Campanacci M,Baldini N,Boriani S,et al.Giant-celltumor of bone[J].J Bone Joint Surg(Am),1987,69(1):106-114.
[5] Gouin F,Rochwerger AR,Di Marco A,et al.Adju-vant treatment with zoledronic acid after extensivecurettage for giant cell tumours of bone[J].Eur JCancer,2014,50(14):2425-2431.
[6]陈皓,吕智,李立志,等.骨巨细胞瘤的治疗进展[J].实用骨科杂志,2017,23(6):522-525.
[7] Enneking WF,Dunham W,Gebhardt MC,et al.Asystem for the functional evaluation of reconstruc-tive procedures after surgical treatment of tumors ofthe musculoskeletal system[J].Clin Orthop RelatRes,1993(286):241-246.
[8] Prosser GH,Baloch KG,Tillman RM,et al.Does cu-rettage without adjuvant therapy provide low recur-rence rates in giant-cell tumors of bone?[J].ClinOrthop Relat Res,2005(435):211-218.
[9] Viswanathan S,Jambhekar NA.Metastatic giant celltumor of bone:are there associated factors and besttreatment modalities?[J].Clin Orthop Relat Res,2010,468(3):827-833. (下转第130页)
[10] Cummins CA,Scarborough MT,Enneking WF.Mul-ticentric giant cell tumor of bone[J].Clin OrthopRelat Res,1996(322):245-252.
[11] Sheth DS,Healey JH,Sobel M,et al.Giant celltumor of the distal radius[J].J Hand Surg Am,1995,20(3):432-440.
[12] McDonald DJ,Sim FH,McLeod RA,et al.Giant-celltumor of bone[J].J Bone Joint Surg(Am),1986,68(2):235-242.
[13] McCarthy EF.Giant-cell tumor of bone:an historicalperspective[J].Clin Orthop Relat Res,1980(153):14-25.
[14] Labs K,Perka C,Schmidt RG.Treatment of stages 2and 3 giant-cell tumor[J].Arch Orthop TraumaSurg,2001,121(1-2):83-86.
[15] Errani C,Ruggieri P,Asenzio MA,et al.Giant celltumor of the extremity:A review of 349cases froma single institution[J].Cancer Treat Rev,2010,36(1):1-7.
[16]牛晓辉.骨巨细胞瘤的诊断与治疗[J].癌症进展,2005,3(4):316-319.
[17] Masui F,Ushigome S,Fujii K.Giant cell tumor ofbone:a clinicopathologic study of prognostic factors[J].Pathol Int,1998,48(9):723-729.
[18] Capanna R,Fabbri N,Bettelli G.Curettage of giantcell tumor of bone.The effect of surgical techniqueand adjuvants on local recurrence rate[J].Chir Orga-ni Mov,1990,75(1Suppl):206.
[19] Kafchitsas K,Habermann B,Proschek D,et al.Func-tional results after giant cell tumor operation nearknee joint and the cement radiolucent zone as indica-tor of recurrence[J].Anticancer Res,2010,30(9):3795-3799.
[20] Kivioja AH,Blomqvist C,Hietaniemi K,et al.Ce-ment is recommended in intralesional surgery of gi-ant cell tumors:a Scandinavian Sarcoma Group stud-y of 294patients followed for a median time of 5years[J].Acta Orthop,2008,79(1):86-93.
[21] O'Donnell RJ,Springfield DS,Motwani HK,et al.Recurrence of giant-cell tumors of the long bones af-ter curettage and packing with cement[J].J BoneJoint Surg(Am),1994,76(12):1827-1833.
[22] Fraquet N,Faizon G,Rosset P,et al.Long bones gi-ant cells tumors:treatment by curretage and cavityfilling cementation[J].Orthop Traumatol Surg Res,2009,95(6):402-406.
[23]鱼锋,张清,郝林,等.股骨近端骨巨细胞瘤的刮除治疗[J].中国骨肿瘤骨病,2007,6(3):133-135.
[24] Radev BR,Kase JA,Askew MJ,et al.Potential forthermal damage to articular cartilage by PMMA re-construction of a bone cavity following tumor exci-sion:A finite element study[J].J Biomech,2009,42(8):1120-1126.
[2] Niu X,Zhang Q,Hao L,et al.Giant cell tumor of theextremity:retrospective analysis of 621Chinese pa-tients from one institution[J].J Bone Joint Surg(Am),2012,94(5):461-467.
[3] Jaffe HL.Giant cell tumor of bone:problems of dif-ferential diagnosis:1944[J].Bull Hosp Jt Dis,1995,54(2):109-112.
[4] Campanacci M,Baldini N,Boriani S,et al.Giant-celltumor of bone[J].J Bone Joint Surg(Am),1987,69(1):106-114.
[5] Gouin F,Rochwerger AR,Di Marco A,et al.Adju-vant treatment with zoledronic acid after extensivecurettage for giant cell tumours of bone[J].Eur JCancer,2014,50(14):2425-2431.
[6]陈皓,吕智,李立志,等.骨巨细胞瘤的治疗进展[J].实用骨科杂志,2017,23(6):522-525.
[7] Enneking WF,Dunham W,Gebhardt MC,et al.Asystem for the functional evaluation of reconstruc-tive procedures after surgical treatment of tumors ofthe musculoskeletal system[J].Clin Orthop RelatRes,1993(286):241-246.
[8] Prosser GH,Baloch KG,Tillman RM,et al.Does cu-rettage without adjuvant therapy provide low recur-rence rates in giant-cell tumors of bone?[J].ClinOrthop Relat Res,2005(435):211-218.
[9] Viswanathan S,Jambhekar NA.Metastatic giant celltumor of bone:are there associated factors and besttreatment modalities?[J].Clin Orthop Relat Res,2010,468(3):827-833. (下转第130页)
[10] Cummins CA,Scarborough MT,Enneking WF.Mul-ticentric giant cell tumor of bone[J].Clin OrthopRelat Res,1996(322):245-252.
[11] Sheth DS,Healey JH,Sobel M,et al.Giant celltumor of the distal radius[J].J Hand Surg Am,1995,20(3):432-440.
[12] McDonald DJ,Sim FH,McLeod RA,et al.Giant-celltumor of bone[J].J Bone Joint Surg(Am),1986,68(2):235-242.
[13] McCarthy EF.Giant-cell tumor of bone:an historicalperspective[J].Clin Orthop Relat Res,1980(153):14-25.
[14] Labs K,Perka C,Schmidt RG.Treatment of stages 2and 3 giant-cell tumor[J].Arch Orthop TraumaSurg,2001,121(1-2):83-86.
[15] Errani C,Ruggieri P,Asenzio MA,et al.Giant celltumor of the extremity:A review of 349cases froma single institution[J].Cancer Treat Rev,2010,36(1):1-7.
[16]牛晓辉.骨巨细胞瘤的诊断与治疗[J].癌症进展,2005,3(4):316-319.
[17] Masui F,Ushigome S,Fujii K.Giant cell tumor ofbone:a clinicopathologic study of prognostic factors[J].Pathol Int,1998,48(9):723-729.
[18] Capanna R,Fabbri N,Bettelli G.Curettage of giantcell tumor of bone.The effect of surgical techniqueand adjuvants on local recurrence rate[J].Chir Orga-ni Mov,1990,75(1Suppl):206.
[19] Kafchitsas K,Habermann B,Proschek D,et al.Func-tional results after giant cell tumor operation nearknee joint and the cement radiolucent zone as indica-tor of recurrence[J].Anticancer Res,2010,30(9):3795-3799.
[20] Kivioja AH,Blomqvist C,Hietaniemi K,et al.Ce-ment is recommended in intralesional surgery of gi-ant cell tumors:a Scandinavian Sarcoma Group stud-y of 294patients followed for a median time of 5years[J].Acta Orthop,2008,79(1):86-93.
[21] O'Donnell RJ,Springfield DS,Motwani HK,et al.Recurrence of giant-cell tumors of the long bones af-ter curettage and packing with cement[J].J BoneJoint Surg(Am),1994,76(12):1827-1833.
[22] Fraquet N,Faizon G,Rosset P,et al.Long bones gi-ant cells tumors:treatment by curretage and cavityfilling cementation[J].Orthop Traumatol Surg Res,2009,95(6):402-406.
[23]鱼锋,张清,郝林,等.股骨近端骨巨细胞瘤的刮除治疗[J].中国骨肿瘤骨病,2007,6(3):133-135.
[24] Radev BR,Kase JA,Askew MJ,et al.Potential forthermal damage to articular cartilage by PMMA re-construction of a bone cavity following tumor exci-sion:A finite element study[J].J Biomech,2009,42(8):1120-1126.