四肢长骨初治骨巨细胞瘤患者疗效及术后复发危险因素分析
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摘要
目的探讨四肢长骨初治骨巨细胞瘤患者疗效及术后复发危险因素。方法选取2014年5月至2017年4月间武汉市汉阳医院收治的80例四肢长骨骨巨细胞瘤患者为研究对象。观察四肢长骨初治骨巨细胞瘤患者治疗后的临床疗效及术后复发危险因素。结果 80例患者中,有4例患者发生局部复发现象,患者的复发时间为4～52个月。单纯骨组织复发3例,其中,近关节面侧2例,远关节面侧1例;单纯软组织复发1例。1例患者复发2次,其余患者均经第二次手术痊愈。患者局部复发率与患者的性别、手术方式、Campanacci分级和是否发生病理性骨折均无关系。患者的年龄与患者局部复发率有关。结论骨巨细胞瘤的复发与患者的发病年龄相关,与患者手术方式、临床资料及影像学特点等均无显著相关性,若患者情况允许,可优先选择扩大刮除术治疗。
Objective To observe the efficacy of primary treatment of giant cell tumor in long bones and risk factors for postoperative recurrence. Methods From May 2014 to April 2017,80 patients with giant cell tumors in long bones were treated at Wuhan General Hospital of Guangzhou Military Region.The clinical efficacy and risk factors for recurrence after the surgical treatment were observed. Results Among the 80 patients,local recurrence occurred in 4 patients with the recurrence period of 4 to 5 months.Bone tissue associated recurrence occurred in 3 patients with 2 in proximal articular surface and 1 in distal proximal articular surface. Bone tissue associated recurrence occurred in 1 patient and relapsed twice in 1 patient. The rest were cured after the surgery. The local recurrence rate was not associated with gender,surgery,Campanacci staging,and pathological fracture( P > 0. 05) rather than it was associated with the age( P < 0. 05). Conclusion There was no significant correlation between the recurrence factors of giant cell tumor of bone and the operative method,clinical data and imaging features. Extended curettage is an ideal method for the treatment of giant cell tumor of bone,depending on the patient's condition.
Objective To observe the efficacy of primary treatment of giant cell tumor in long bones and risk factors for postoperative recurrence. Methods From May 2014 to April 2017,80 patients with giant cell tumors in long bones were treated at Wuhan General Hospital of Guangzhou Military Region.The clinical efficacy and risk factors for recurrence after the surgical treatment were observed. Results Among the 80 patients,local recurrence occurred in 4 patients with the recurrence period of 4 to 5 months.Bone tissue associated recurrence occurred in 3 patients with 2 in proximal articular surface and 1 in distal proximal articular surface. Bone tissue associated recurrence occurred in 1 patient and relapsed twice in 1 patient. The rest were cured after the surgery. The local recurrence rate was not associated with gender,surgery,Campanacci staging,and pathological fracture( P > 0. 05) rather than it was associated with the age( P < 0. 05). Conclusion There was no significant correlation between the recurrence factors of giant cell tumor of bone and the operative method,clinical data and imaging features. Extended curettage is an ideal method for the treatment of giant cell tumor of bone,depending on the patient's condition.
引文
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[18]郭卫,杨毅.骨巨细胞瘤的外科治疗方法[J].中国骨与关节杂志,2016,5:1-3.
[19]钟传山,付志彬.桡骨远端骨巨细胞瘤切除术后自体腓骨头移植重建腕关节的远期疗效[J].中国肿瘤临床与康复,2016,23:1102-1104.
[2]Li X,Guo W,Yang Y,et al.Surgical treatment for long bone giant cell tumor of extremity with pathologic fracture[J].Beijing Daxue Xuebao,2013,45:745-751.
[3]Niu X,Zhang Q,Hao L,et al.Giant cell tumor of the extremity:retrospective analysis of 621 Chinese patients from one institution[J].J Bone Joint Surg Am,2012,94:461-467.
[4]徐海荣,牛晓辉.四肢长骨初治骨巨细胞瘤的复发因素分析[J].中华肿瘤杂志,2014,36:465-468.
[5]林鹏,林秾,李冰皓,等.经病灶手术治疗颈椎骨巨细胞瘤的疗效[J].中华骨科杂志,2018,38:353-360.
[6]马建国,阴彦兵.部分边缘外肿瘤切除联合病灶内刮除术对股骨远端骨巨细胞瘤的疗效评价[J].实用癌症杂志,2017,32:1901-1903.
[7]Li R,Hu Y.Meta-analysis of risk factors of recurrence in patients with giant cell tumor on extremities[J].Zhonghua Yixue Zazhi,2014,94:3778-3783.
[8]Oda Y,Miura H,Tsuneyoshi M,et al.Giant cell tumor of bone:oncological and functional results of long-term follow-up[J].Jap J Clin Oncol,1998,28:323-328.
[9]易春智,方斌,蓝鋆.桡、尺骨远端骨巨细胞瘤的手术治疗及疗效分析[J].中国中医骨伤科杂志,2017,25:48-52.
[10]李孟泽,黄丛改,汪永泉,等.116例骨巨细胞瘤手术患者的临床特点及疗效分析[J].中国医刊,2017,52:58-60.
[11]李艳,伊航,李锦明,等.囊内刮除术和囊外切除术对股骨巨细胞瘤的治疗效果对比研究[J].实用癌症杂志,2016,31:506-508.
[12]杨毅,郭卫,杨荣利,等.地诺单抗联合手术治疗桡骨远端骨巨细胞瘤---外科降级及预后[J].骨科,2018(1).
[13]Tremaine WH,Dixon PM.A long-term study of 277 cases of equine sinonasal disease.Part 2:Treatments and results of treatments[J].Equine Vet J,2001,33:283-289.
[14]Chung SW,Han I,Oh JH,et al.Prognostic effect of erroneous surgical procedures in patients with osteosarcoma:evaluation using propensity score matching[J].J Bone Joint Surg Am,2014,96:e60.
[15]O'Connor W,Quintana M,Smith S,et al.The hypermetabolic giant:18F-FDG avid giant cell tumor identified on PET-CT[J].J Radiol Case Rep,2014,8:27-38.
[16]宋光泽,赵慧霞.膝关节周围骨巨细胞瘤刮除术后填充骨水泥对关节功能影响[J].现代仪器与医疗,2018,24:53-55.
[17]卢炜,向阳.刮除植骨与广泛切除肿瘤假体置换治疗四肢大关节骨巨细胞瘤[J].中国组织工程研究,2016,22:193-193.
[18]郭卫,杨毅.骨巨细胞瘤的外科治疗方法[J].中国骨与关节杂志,2016,5:1-3.
[19]钟传山,付志彬.桡骨远端骨巨细胞瘤切除术后自体腓骨头移植重建腕关节的远期疗效[J].中国肿瘤临床与康复,2016,23:1102-1104.