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目的探讨不同手术方式对骨巨细胞瘤疗效的影响。方法 1991年1月至2005年12月我院治疗长骨骨巨细胞瘤59例。男28例,女31例。平均年龄32.5岁。刮除植骨术8例次、刮除+灭活+瘤腔内化疗+植骨术16例次、瘤段切除自体骨移植术14例次、瘤段切除人工关节置换术22例次、截肢术4例次、瘤段切除灭活再植术3例次。分析刮除+灭活+瘤腔内化疗+植骨术、瘤段切除自体骨移植术、瘤段切除人工关节置换术3种手术方式对术后复发、肢体功能、综合评定的影响。结果本组患者均获得随访,平均51(14～168)个月。术后复发7例,其中刮除植骨术3例,刮除、灭活、瘤腔内化疗、植骨术2例,瘤段切除人工关节置换术1例,瘤段切除灭活再植术1例。5种手术方式(除截肢术外)肢体功能平均得分分别为28.4、28.1、25.7、22.6、21.3。术后综合评定优良率分别为62.5%、81.3%、57.1%、54.6%、0%、33.3%。结论从降低术后复发率和保留肢体功能角度而言,刮除灭活植骨并行瘤腔内化疗是治疗骨巨细胞瘤较理想的手术方式。对于瘤段切除假体置换术应严格掌握适应证。
Objective To investigate the effect of different surgical methods on the treatment of giant cell tumor of bone. Methods January 1991 to December 2005 treatment of 59 cases of long bone giant cell tumor in our hospital. 28 males and 31 females. The average age is 32.5 years old. 8 cases of curettage and bone grafting, 16 cases of curettage + inactivation + tumor chemotherapy + bone graft, 14 cases of tumor resection and autologous bone graft, 22 cases of tumor resection and artificial joint replacement, 4 cases of surgery, tumor resection inactivated replantation in 3 cases. Analysis of curettage + inactivation + intraluminal chemotherapy + bone graft, tumor resection autologous bone graft, resection of tumor resection joint prosthesis three kinds of operation on postoperative recurrence, limb function, comprehensive evaluation. Results The patients were followed up for an average of 51 (14 ~ 168) months. Seven cases had recurrence after surgery, including 3 cases of curettage and bone grafting, curettage and inactivation, tumor cavity chemotherapy and bone grafting in 2 cases, tumor resection and arthroplasty in 1 case, tumor resection inactivated replantation 1 case. Five kinds of surgical procedures (except amputation) physical function average score was 28.4,28.1,25.7,22.6,21.3. Postoperative comprehensive assessment of excellent and good rates were 62.5%, 81.3%, 57.1%, 54.6%, 0%, 33.3%. Conclusion From the point of view of reducing the recurrence rate and preserving limb function, the cure of giant cell tumor of giant cell tumor is an ideal surgery for the treatment of giant cell tumor of bone. Tumor resection prosthesis replacement should be strictly controlled indications.