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目的探讨唑来膦酸对脊柱骨巨细胞瘤术中出血及术后复发的可能影响。方法采用前瞻性、临床观察性对照研究。唑来膦酸组:患者于术前1周使用唑来膦酸4mg,术后3周再使用唑来膦酸4mg,此后每4周使用唑来膦酸4mg,直至术后3年或患者不能耐受。对照组:患者在术前与术后均不使用唑来膦酸及二膦酸盐类药物。记录所有患者术中出血量。患者术后每6个月进行一次影像学随访,以明确是否复发。结果共53例符合条件的患者入选本研究,唑来膦酸组28例,对照组25例。唑来膦酸组患者术中平均出血量为(1 594±847)mL(400～3 200mL),对照组为(2 476±769)mL(800～4 000mL),差异有统计学意义(P<0.05)。唑来膦酸组患者3年内无复发,且无一例出现严重不良反应;对照组4例出现局部复发(2例在术后24个月时,2例在术后36个月时)。对照组患者3年复发率(16%)高于唑来膦酸组,差异有统计学意义(χ2=4.846,P=0.028)。结论术前辅助使用唑来膦酸可能有利于抑制脊柱骨巨细胞瘤术中出血,术后长期应用唑来膦酸可能有助于预防肿瘤复发,相关结论仍有待大样本随机对照研究证实。
Objective To investigate the possible effect of zoledronic acid on intraoperative bleeding and postoperative recurrence of giant cell tumor of the spine. Methods The prospective, clinical observational control study. Zoledronic acid group: patients using zoledronic acid 4mg 1 week before surgery, 3 weeks after the use of zoledronic acid 4mg, every 4 weeks thereafter zoledronic acid 4mg until after 3 years or patients can not Tolerance. Control group: patients did not use zoledronic acid and bisphosphonates before and after operation. Record all patients intraoperative blood loss. Patients were followed up every 6 months to find out whether recurrence occurred. Results A total of 53 eligible patients were enrolled in this study, 28 in the zoledronic acid group and 25 in the control group. The mean intraoperative blood loss was (1594 ± 847) mL (400 ~ 3 200 mL) in the zoledronic acid group and (2 476 ± 769) mL (800 ~ 4 000 mL) in the control group, with significant difference (P <0.05). Patients in the zoledronic acid group had no recurrence within 3 years and no serious adverse reactions occurred in 4 patients. Local recurrence occurred in 4 patients in the control group (2 patients at 24 months and 2 patients at 36 months after operation). The 3-year recurrence rate (16%) in the control group was significantly higher than that in the zoledronic acid group (χ2 = 4.846, P = 0.028). Conclusion Preoperative adjuvant zoledronic acid may be helpful to inhibit the intraoperative bleeding of giant cell tumor of the spine. Long-term application of zoledronic acid may help prevent tumor recurrence after the operation, and the relevant conclusion remains to be confirmed by randomized controlled large study.