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[目的]探讨复发性肢体骨巨细胞瘤的临床、影像学特点以及不同治疗方法及临床疗效。[方法]自1995年1月~2009年1月治疗29例复发性骨巨细胞瘤,男15例,女14例;复发时平均年龄32.4岁(13~56)岁;股骨远端和胫骨近端各12例,肱骨近端2例,股骨近端、尺骨远端、腓骨近端各1例。首次手术方式与例数:肿瘤刮除植骨26例,瘤段切除骨缺损修复术2例,单纯腓骨近端切除术1例。复发平均时间26.6个月(1~168)个月。再次手术方式与例数:瘤段切除骨缺损修复重建术17例(假体置换14例,自体骨移植2例,灭活再植1例);肿瘤扩大刮除瘤腔灭活骨修复术7例(植骨4例,骨水泥填充内固定3例),肿瘤扩大切除术3例;截肢术2例。[结果]随访时间24~180个月,平均70个月。2例再次复发;总再复发率为6.9%,肿瘤切除骨缺损修复组无复发,病灶内手术组中1例复发(1/7,14.29%),局部扩大切除术组1例复发(1/3,33.33%)。随访期内2例死亡(1例死于非肿瘤原因)。病灶内手术组肢体功能优良率为100%,瘤段切除骨缺损修复组为73.33%。综合临床疗效评价病灶内手术优良率为85.71%。肿瘤切除骨缺损修复组为66.67%。[结论]骨巨细胞瘤术后定期随访对于早期诊断肿瘤复发至关重要;一旦复发诊断明确,尽管存在再次复发的风险,应首选瘤灶内手术;对放射学CompanacciⅢ级的复发性骨巨细胞瘤可选择瘤段切除骨缺损重建手术治疗,但存在一定的远期并发症。
[Objective] To investigate the clinical and imaging characteristics of recurrent limb giant cell tumor and its different treatment methods and clinical effects. [Methods] From January 1995 to January 2009, 29 patients with recurrent giant cell tumor of bone were treated. There were 15 males and 14 females. The average age was 32.4 years (ranged from 13 to 56 years) at the time of recurrence. The distal femur and tibia 12 cases in each end, 2 cases in the proximal humerus, 1 proximal femur, 1 distal ulna and 1 proximal fibula. The first operation and the number of cases: tumor curettage and bone graft in 26 cases, tumor resection and bone defect repair in 2 cases, simple fibular proximal resection in 1 case. The average recurrence time was 26.6 months (range, 1 ~ 168) months. Re-operation mode and number of cases: Tumor resection 17 cases of bone defect repair and reconstruction (prosthesis replacement in 14 cases, autologous bone graft in 2 cases, inactivated replantation in 1 case); (4 cases of bone graft and 3 cases of cement-filled internal fixation), 3 cases of tumor enlargement and resection and 2 cases of amputation. [Results] The follow-up time ranged from 24 to 180 months with an average of 70 months. The recurrence rate was 6.9% in the 2 cases. There was no recurrence in the resected bone defect group, 1 case was recurrence in the lesion group (1 / 7,14.29%), and 1 case was locally enlarged resection group (1 / 3,33.33%). Two patients died during the follow-up period (one died of non-tumor causes). The excellent and good rate of limb function in operation group was 100%, and 73.33% in resection of tumor segment. The comprehensive clinical curative effect evaluation of intraoperative lesions was 85.71%. Tumor resection bone defect repair group was 66.67%. [Conclusion] Periodontal follow-up of giant cell tumor of the bone is very important for the early diagnosis of tumor recurrence. Once the diagnosis of recurrence is clear, the intraoperative neo-tumor should be selected in spite of the recurrence risk. The radiographic companacci grade III recurrent giant cell Tumor resection of segmental bone defect reconstruction surgery, but there are some long-term complications.