• 四川大學(xué)華西醫(yī)院骨科（成都，610041）;

目的 探討四肢骨巨細(xì)胞瘤術(shù)后復(fù)發(fā)患者再次手術(shù)術(shù)式選擇及療效。 方法回顧1988年2月－2007年6月收治且獲完整隨訪的79例骨巨細(xì)胞瘤術(shù)后復(fù)發(fā)再次手術(shù)患者臨床資料。男42例，女37例；年齡15～72歲，平均33.1歲。初次行囊內(nèi)刮除76例，整塊切除3例；初次手術(shù)后2～176個月腫瘤局部復(fù)發(fā)。腫瘤病灶位于上肢14例，下肢65例。初次手術(shù)前影像學(xué)Companacci分級，Ⅰ級1例、Ⅱ級33例、Ⅲ級45例。再次手術(shù)37例采用囊內(nèi)刮除植骨聯(lián)合輔助滅活，42例采用腫瘤整塊切除治療。 結(jié)果術(shù)后2例出現(xiàn)同種異體骨免疫排斥反應(yīng)，導(dǎo)致切口不愈合；余患者切口均Ⅰ期愈合?；颊呔@隨訪，隨訪時間18～221個月，平均68個月。其中12例于術(shù)后6～32個月局部再次復(fù)發(fā)，采用囊內(nèi)刮除植骨聯(lián)合輔助滅活措施者中再復(fù)發(fā)9例（24.3%，9/37），均再次行腫瘤整塊切除；腫瘤整塊切除再復(fù)發(fā)3 例（7.1%，3/42），均截肢；兩種術(shù)式復(fù)發(fā)率比較差異有統(tǒng)計學(xué)意義（χ2=4.508，P=0.034）；再復(fù)發(fā)患者術(shù)后隨訪3年均未見復(fù)發(fā)。 結(jié)論復(fù)發(fā)性四肢骨巨細(xì)胞瘤可以通過囊內(nèi)刮除植骨聯(lián)合輔助滅活治療，但腫瘤局部復(fù)發(fā)率高于腫瘤整塊切除。對于腫瘤范圍超過橫斷面50%預(yù)測不能徹底刮除及惡性復(fù)發(fā)性骨巨細(xì)胞瘤患者，建議采用腫瘤整塊切除方法。

引用本文： 孔清泉,楊進(jìn),幸?guī)V,屠重棋,周勇,張暉,段宏. 四肢骨巨細(xì)胞瘤術(shù)后復(fù)發(fā)再次手術(shù)的療效觀察. 中國修復(fù)重建外科雜志, 2013, 27(1): 36-40. doi: 復(fù)制

1. Balke M, Schremper L, Gebert C, et al. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol, 2008, 134(9): 969-978.
2. Klenke FM, Wenger DE, Inwards CY, et al. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res, 2011, 469(2): 591-599.
3. Gupta R, Seethalakshmi V, Jambhekar NA, et al. Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India. Ann Diagn Pathol, 2008, 12(4): 239-248.
4. Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res, 1995, (321): 245-250.
5. Balke M, Ahrens H, Streitbuerger A, et al. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol, 2009, 135(1): 149-158.
6. Pietschmann MF, Dietz RA, Utzschneider S, et al. The influence of adjuvants on local recurrence rate in giant cell tumour of the bone. Acta Chir Belg, 2010, 110(6): 584-589.
7. Wan R, Zhang W, Xu J, et al. The outcome of surgical treatment for recurrent giant cell tumor in the appendicular skeleton. J Orthop Sci, 2012, 17(4): 464-469.
8. Balke M, Campanacci L, Gebert C, et al. Bisphosphonate treatment of aggressive primary, recurrent and metastatic Giant Cell Tumour of Bone. BMC Cancer, 2010, 10: 462.
9. Kriz J, Eich HT, Mücke R, et al. Radiotherapy for giant cell tumors of the bone: a safe and effective treatment modality. Anticancer Res, 2012, 32(5): 2069-2073.
10. Bhatia S, Miszczyk L, Roelandts M, et al. Radiotherapy for marginally resected, unresectable or recurrent giant cell tumor of the bone: a rare cancer network study. Rare Tumors, 2011, 3(4): e48.
11. Tse LF, Wong KC, Kumta SM, et al. Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: a case-control study. Bone, 2008, 42(1): 68-73.
12. Klenke FM, Wenger DE, Inwards CY, et al. Recurrent giant cell tumor of long bones: analysis of surgical management. Clin Orthop Relat Res, 2011, 469(4): 1181-1187.
13. Yu XC, Xu M, Song RX, et al. Long-term outcome of giant cell tumors of bone around the knee treated by en bloc resection of tumor and reconstruction with prosthesis. Orthop Surg, 2010, 2(3): 211-217.
14. Lv C, Tu C, Min L, et al. Allograft arthrodesis of the knee for giant cell tumors. Orthopedics, 2012, 35(3): e397-402.
15. 畢鄭鋼, 潘琦, 付春江, 等. 吻合血管腓骨小頭移植重建腕關(guān)節(jié)治療橈骨遠(yuǎn)端骨巨細(xì)胞瘤. 中國修復(fù)重建外科雜志, 2010, 24(12): 1416-1418.
16. Arredondo-Gómez E, Pasos Novelo FJ, Vargas Mena R. Treatment of recurrent giant cell tumor of the tibia with en bloc resections, bone transport and arthrodesis using an AO type external fixations system. A case report. Acta Ortop Mex, 2009, 23(2): 98-102.
17. Kim H, Lee SK, Kim KJ, et al. Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator. Int Orthop, 2009, 33(3): 835-841.
18. Anract P, De Pinieux G, Cottias P, et al. Malignant giant-cell tumours of bone. Clinico-pathological types and prognosis: a review of 29 cases. Int Orthop, 1998, 22(1): 19-26.
19. Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer, 2003, 97(10): 2520-2529.
20. Takeuchi A, Tsuchiya H, Niu X, et al. The prognostic factors of recurrent GCT: a cooperative study by the Eastern Asian Musculoskeletal Oncology Group. J Orthop Sci, 2011, 16(2): 196-202.
  1. 1. Balke M, Schremper L, Gebert C, et al. Giant cell tumor of bone: treatment and outcome of 214 cases. J Cancer Res Clin Oncol, 2008, 134(9): 969-978.
  2. 2. Klenke FM, Wenger DE, Inwards CY, et al. Giant cell tumor of bone: risk factors for recurrence. Clin Orthop Relat Res, 2011, 469(2): 591-599.
  3. 3. Gupta R, Seethalakshmi V, Jambhekar NA, et al. Clinicopathologic profile of 470 giant cell tumors of bone from a cancer hospital in western India. Ann Diagn Pathol, 2008, 12(4): 239-248.
  4. 4. Bini SA, Gill K, Johnston JO. Giant cell tumor of bone. Curettage and cement reconstruction. Clin Orthop Relat Res, 1995, (321): 245-250.
  5. 5. Balke M, Ahrens H, Streitbuerger A, et al. Treatment options for recurrent giant cell tumors of bone. J Cancer Res Clin Oncol, 2009, 135(1): 149-158.
  6. 6. Pietschmann MF, Dietz RA, Utzschneider S, et al. The influence of adjuvants on local recurrence rate in giant cell tumour of the bone. Acta Chir Belg, 2010, 110(6): 584-589.
  7. 7. Wan R, Zhang W, Xu J, et al. The outcome of surgical treatment for recurrent giant cell tumor in the appendicular skeleton. J Orthop Sci, 2012, 17(4): 464-469.
  8. 8. Balke M, Campanacci L, Gebert C, et al. Bisphosphonate treatment of aggressive primary, recurrent and metastatic Giant Cell Tumour of Bone. BMC Cancer, 2010, 10: 462.
  9. 9. Kriz J, Eich HT, Mücke R, et al. Radiotherapy for giant cell tumors of the bone: a safe and effective treatment modality. Anticancer Res, 2012, 32(5): 2069-2073.
  10. 10. Bhatia S, Miszczyk L, Roelandts M, et al. Radiotherapy for marginally resected, unresectable or recurrent giant cell tumor of the bone: a rare cancer network study. Rare Tumors, 2011, 3(4): e48.
  11. 11. Tse LF, Wong KC, Kumta SM, et al. Bisphosphonates reduce local recurrence in extremity giant cell tumor of bone: a case-control study. Bone, 2008, 42(1): 68-73.
  12. 12. Klenke FM, Wenger DE, Inwards CY, et al. Recurrent giant cell tumor of long bones: analysis of surgical management. Clin Orthop Relat Res, 2011, 469(4): 1181-1187.
  13. 13. Yu XC, Xu M, Song RX, et al. Long-term outcome of giant cell tumors of bone around the knee treated by en bloc resection of tumor and reconstruction with prosthesis. Orthop Surg, 2010, 2(3): 211-217.
  14. 14. Lv C, Tu C, Min L, et al. Allograft arthrodesis of the knee for giant cell tumors. Orthopedics, 2012, 35(3): e397-402.
  15. 15. 畢鄭鋼, 潘琦, 付春江, 等. 吻合血管腓骨小頭移植重建腕關(guān)節(jié)治療橈骨遠(yuǎn)端骨巨細(xì)胞瘤. 中國修復(fù)重建外科雜志, 2010, 24(12): 1416-1418.
  16. 16. Arredondo-Gómez E, Pasos Novelo FJ, Vargas Mena R. Treatment of recurrent giant cell tumor of the tibia with en bloc resections, bone transport and arthrodesis using an AO type external fixations system. A case report. Acta Ortop Mex, 2009, 23(2): 98-102.
  17. 17. Kim H, Lee SK, Kim KJ, et al. Tibial lengthening using a reamed type intramedullary nail and an Ilizarov external fixator. Int Orthop, 2009, 33(3): 835-841.
  18. 18. Anract P, De Pinieux G, Cottias P, et al. Malignant giant-cell tumours of bone. Clinico-pathological types and prognosis: a review of 29 cases. Int Orthop, 1998, 22(1): 19-26.
  19. 19. Bertoni F, Bacchini P, Staals EL. Malignancy in giant cell tumor of bone. Cancer, 2003, 97(10): 2520-2529.
  20. 20. Takeuchi A, Tsuchiya H, Niu X, et al. The prognostic factors of recurrent GCT: a cooperative study by the Eastern Asian Musculoskeletal Oncology Group. J Orthop Sci, 2011, 16(2): 196-202.