膝关节周围骨巨细胞瘤的外科治疗.pdf

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1、临床骨科杂志JournalofClinicalOrthopaedics2015Apr；18(2)·221·doi：10．3969／j．issn．1008-0287．2015．02．031·临床论著·膝关节周围骨巨细胞瘤的外科治疗苏郁，胡扬华，王旭，刘寿坤，王体惠摘要：目的探讨膝关节周围骨巨细胞瘤的临床和影像学特点、手术方式的选择及临床疗效，讨论该病变可接受的外科治疗方式。方法23例膝关节周围骨巨细胞瘤患者(股骨远端1O例，胫骨近端12例，腓骨近端复发并胫骨转移1例)根据病变的临床、影像学特点选择不同手术方式：9

2、例行瘤段切除肿瘤假体置换术；13例行肿瘤扩大刮除瘤腔灭活骨修复和内固定术(植骨9例，骨水泥填充4例)，1例行截肢术。结果患者均获得随访，时间8～50个月。术后3例复发，肿瘤切除骨缺损修复组1例复发，肢体功能评分80％；肿瘤扩大刮除瘤腔灭活骨修复组2例复发，肢体功能评分95％。结论根据膝关节周围骨巨细胞瘤的临床及影像学特点选择合理的治疗方法，对肿瘤复发的控制及后续治疗方面具备一定的优势。关键词：骨肿瘤／J'l-科学；膝关节；骨巨细胞瘤；骨重建中图分类号：R738．1；R687．3文献标识码：A文章编号：1008—

3、0287(2015)02—0221—04ThesurgicaltreatmentofthegiantcelltumoraroundthekneejointSUYu，HUy一hua，WANG，Shou—Kun，WANG死一hui(DeptofBoneTumorandBoneDisease，MingdongHospi—talAffiliatedtoFufianMedicalUniversity，Fuan，Fufian355000，China)Abstract：ObjectiveToexploretheclinica

4、landimagingcharacteristics，thecorrespondingoperationmethodandclinicaleffectofthegiantcelltumoraroundthekneejoint，anddiscusstheselectionofsurgicaloptionsofthelesion．Methods23patientswithgiantcelltumoraroundthekneejointwereretrospectivelyanalyzed，10distalfemur

5、casesand12proximaltibiacasesand1caseofproximalfibulatumorcombinedwithtibiametastasiswereincludedinthestudy．SurgicalmethodWaschosenaccordingtotheclinicalandimagingcharacteristicsofthepathologicalchanges：9casesremovalofthesegmentaltumorandjointprosthesisreplac

6、ement；Extensivelycurettageandinactivationofthetumorcavityfor13cases，thenfilledthecavitywithbonegraftorcementandusingfixation(9casesofbonegraft，4casesofcement)，amputationin1case．ResultsAllcaseswerefollowedupfor8～50months．Tumorrecurredin3casespostoperation．1ca

7、serecuredinthegroupofresectionoftumorsegmentandtumorprosthesisreplacement．2casesrecurredinthegroupofextendedtumorcurettageandbonerepairofthedevitalizedtumorcavity．Thelimbfunctionalscoreofthetwogroupswere80％and95％respectively．CondusionsAreasonabletreatmentbas

8、edontheclinicalandimagingcharacteristicsofgiantcelltumorshouldbechoseninordertoobtainagoodlocalcontrolandlimbfunctions．Keywords：boneneoplasms／surgery；kneejoint；siamcelltumorofbone；bonereconstruc