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[目的]回顾不同手术方法治疗四肢部位骨巨细胞瘤术后肢体功能恢复、肿瘤复发情况,分析影响局部复发因素。[方法]2003年9月～2009年9月收治35例单发骨巨细胞瘤患者,男19例,女16例;发病年龄21～45岁,平均28.6岁;Campanicci分级:Ⅰ级13例,Ⅱ级18例,Ⅲ级4例。对于CampanicciⅠ～Ⅱ级,治疗方法 A:开窗病灶刮除+气动磨钻打磨+电刀烧灼+95%酒精烧灼+植骨(自体髂骨或与人工骨混合植骨);方法 B:开窗病灶刮除+气动磨钻打磨+电刀烧灼+95%酒精烧灼+骨水泥充填。CampanicciⅢ级,方法 C:关节置换。[结果]本组35例均获随访,随访时间24～72个月,平均31个月。术后复发6例,复发率为17.14%;CampanicciⅠ～Ⅱ级复发率16.13%,CampanicciⅢ级复发率25%;方法 A组复发率17.65%,B组复发率15.38%,C组复发率20%。[结论]病灶刮除植骨是治疗骨巨细胞瘤的基本方法,人工关节置换能够迅速恢复关节功能,术式选择要慎重;局部病灶残留是术后复发的主要原因之一;加强随访尽早发现复发,利于及时采取补救措施。
[Objective] To review the different surgical methods for the treatment of limb giant cell tumor of limbs after functional recovery, tumor recurrence, analysis of local recurrence factors. [Methods] From September 2003 to September 2009, 35 patients with single giant cell tumor of the brain were treated. There were 19 males and 16 females with a mean age of 28.6 years. The age of onset was 21-45 years. Campanicci grade was 13 grade Ⅰ, Ⅱ grade 18 cases, Ⅲ grade 4 cases. For Campanicci Ⅰ ~ Ⅱ grade, treatment A: fenestration lesion + pneumatic drill sanding + electrocautery cauterization + 95% alcohol cautery + bone graft (autologous iliac or mixed bone graft); Method B: window Scratch curettage + pneumatic drill grinding + electrocautery burning + 95% alcohol burning + bone cement filling. Campanicci grade III, method C: joint replacement. [Results] All 35 patients were followed up for 24 to 72 months with an average of 31 months. The recurrence rate was 17.14%. The recurrence rate of Campanicci Ⅰ ~ Ⅱ was 16.13% and the recurrence rate of Campanicci Ⅲ was 25%. The recurrence rate was 17.65% in group A, 15.38% in group B and 20% in group C. [Conclusion] The curettage and bone grafting is the basic method for the treatment of giant cell tumor of bone. Artificial joint replacement can quickly restore the joint function and the operation method should be carefully chosen. The residual of local lesion is one of the main causes of postoperative recurrence. Recurrence, help to take timely remedial measures.