中国修复重建外科杂志

中国修复重建外科杂志

扩大刮除术治疗软骨母细胞瘤的疗效观察

查看全文

目的 探讨扩大刮除术治疗软骨母细胞瘤的疗效。 方法 回顾性分析 2011 年 1 月—2016 年 5 月,采用病灶扩大刮除术治疗的 37 例软骨母细胞瘤患者临床资料。男 24 例,女 13 例;年龄 12~30 岁,中位年龄 17 岁。原发患者 32 例,复发患者 5 例。患者均以局部疼痛为首发症状。病程 2~8 个月,平均 4.9 个月。病变部位:股骨远端 10 例,股骨近端 7 例,胫骨近端 9 例,肱骨近端 5 例,髌骨 2 例,距骨 1 例,跟骨 1 例,骨盆 2 例。根据良性骨肿瘤的 Enneking 分期均为 3 期。病灶长径为 1.2~6.9 cm,平均 3.2 cm。19 例病变累及骺板。 结果 术后切口均Ⅰ期愈合,无相关并发症发生。患者均获随访,随访时间 12~76 个月,平均 40.5 个月。末次随访时国际肌肉骨骼肿瘤学会(MSTS)评分为(27.5±1.4)分,与术前(18.5±1.9)分比较,差异有统计学意义(t=23.462,P=0.000)。术后 5 个月复发 1 例(2.7%)。X 线片复查示,6 例出现部分植骨吸收,但植骨区关节面未见明显塌陷。3 例骺板受累且病变位于膝关节周围者,出现肢体短缩畸形,但无内外翻畸形,膝关节活动未受影响。 结论 扩大刮除术治疗软骨母细胞瘤具有术后复发率低、肢体功能良好、骨骼发育畸形发生率低等优点,是治疗该疾病较好方法。

Objective To explore the effectiveness of expanded curettage in the treatment of chondroblastoma. Methods The clinical data of 37 patients with chondroblastoma who were treated with expanded curettage between January 2011 and May 2016 were retrospectively analyzed. There were 24 males and 13 females, with a median age of 17 years (range, 12-30 years). There were 32 primary patients and 5 recurrent patients. Local pain was the first symptom in all patients. The average disease duration was 4.9 months (range, 2-8 months). The lesions were located in the distal femur in 10 cases, the proximal femur in 7 cases, the proximal tibia in 9 cases, the proximal humerus in 5 cases, the patella in 2 cases, the talus in 1 case, the calcaneus in 1 case, and pelvis in 2 cases. According to the Enneking staging of benign bone tumors, all tumors were rated as the 3rd stage. The length of the lesion ranged from 1.2 to 6.9 cm (mean, 3.2 cm). The lesions involved the epiphyseal plate in 19 cases. Results All incisions healed by first intention, and no complications occurred. All patients were followed up 12-76 months, with an average of 40.5 months. At last follow-up, the Musculoskeletal Tumor Society (MSTS) score was 27.5±1.4, and the difference was significant when compared with pre-operative value (18.5±1.9) (t=23.462, P=0.000). The chondroblastoma recurred in 1 case (2.7%) after 5 months. X-ray film showed that bone resorption was found in 6 cases, but there was no obvious collapse in the articular surface of bone graft. The limb shortening deformity occurred in 3 cases who were epiphyseal plate involvement patients and lesions located around the knee joint. But there was no varus deformity, and knee joint activity was not affected. Conclusion Expanded curettage has advantages of low incidence of recurrence and skeletal deformity, good limb function, and it is one of the ideal options for chondroblastoma.

关键词: 软骨母细胞瘤; 扩大刮除术; 关节功能

Key words: Chondroblastoma; expanded curettage; joint function

引用本文: 刘擎, 罗伟, 章灿, 廖瞻, 万军, 刘育鹏, 何洪波. 扩大刮除术治疗软骨母细胞瘤的疗效观察. 中国修复重建外科杂志, 2017, 31(12): 1438-1441. doi: 10.7507/1002-1892.201706068 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Springfield DS, Capanna R, Gherlinzoni F, et al. Chondroblastoma. A review of seventy cases. J Bone Joint Surg (Am), 1985, 67(5): 748-755.
2. Dahlin DC, Ivins JC. Benign chondroblastoma. A study of 125 cases. Cancer, 1972, 30(2): 401-413.
3. Schajowicz F, Gallardo H. Epiphysial chondroblastoma of bone. A clinico-pathological study of sixty-nine cases. J Bone Joint Surg (Br), 1970, 52(2): 205-226.
4. Strong DP, Grimer RJ, Carter SR, et al. Chondroblastoma of the femoral head: management and outcome. Int Orthop, 2010, 34(3): 413-417.
5. Garin IE, Wang EH. Chondroblastoma. J Orthop Surg (Hong Kong), 2008, 16(1): 84-87.
6. Lin PP, Thenappan A, Deavers MT, et al. Treatment and prognosis of chondroblastoma. Clin Orthop Relat Res, 2005, (438): 103-109.
7. de Silva MV, Reid R. Chondroblastoma: varied histologic appearance, potential diagnostic pitfalls, and clinicopathologic features associated with local recurrence. Ann Diagn Pathol, 2003, 7(4): 205-213.
8. De Mattos CB, Angsanuntsukh C, Arkader A, et al. Chondroblastoma and chondromyxoid fibroma. J Am Acad Orthop Surg, 2013, 21(4): 225-233.
9. Hsu CC, Wang JW, Chen CE, et al. Results of curettage and high-speed burring for chondroblastoma of the bone. Chang Gung Med J, 2003, 26(10): 761-767.
10. Lehner B, Witte D, Weiss S. Clinical and radiological long-term results after operative treatment of chondroblastoma. Arch Orthop Trauma Surg, 2011, 131(1): 45-52.
11. Ramappa AJ, Lee FY, Tang P, et al. Chondroblastoma of bone. J Bone Joint Surg (Am), 2000, 82-A(8): 1140-1145.
12. Gouin F, Rochwerger AR, Di Marco A, et al. Adjuvant treatment with zoledronic acid after extensive curettage for giant cell tumours of bone. Eur J Cancer, 2014, 50(14): 2425-2431.
13. Algawahmed H, Turcotte R, Farrokhyar F, et al. High-Speed Burring with and without the Use of Surgical Adjuvants in the Intralesional Management of Giant Cell Tumor of Bone: A Systematic Review and Meta-Analysis. Sarcoma, 2010, 2010: 1-5.
14. Enneking WF, Spanier SS, Goodman MA. A system for the surgical staging of musculoskeletal sarcoma. 1980. Clin Orthop Relat Res, 2003, (415): 4-18.
15. Enneking WF, Dunham W, Gebhardt MC, et al. A system for the functional evaluation of reconstructive procedures after surgical-treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res, 1993, (286): 241-246.
16. Zhang K, Gao Y, Dai H, et al. Chondroblastoma of the talus: a case report and literature review. J Foot Ankle Surg, 2012, 51(2): 262-265.
17. Ushigome S, Takakuwa T, Shinagawa T, et al. Ultrastructure of cartilaginous tumors and S-100 protein in the tumors. With reference to the histogenesis of chondroblastoma, chondromyxoid fibroma and mesenchymal chondrosarcoma. Acta Pathol Jpn, 1984, 34(6): 1285-1300.
18. Xu H, Nugent D, Monforte HL, et al. Chondroblastoma of bone in the extremities: a multicenter retrospective study. J Bone Joint Surg (Am), 2015, 97(11): 925-931.
19. Huvos AG, Marcove RC. Chondroblastoma of bone. A critical review. Clin Orthop Relat Res, 1973, (95): 300-312.
20. Jaffe HL, Lichtenstein L. Benign Chondroblastoma of Bone: A Reinterpretation of the So-Called Calcifying or Chondromatous Giant Cell Tumor. Am J Pathol, 1942, 18(6): 969-991.
21. 鱼锋, 张清, 郝林, 等. 软骨母细胞瘤 65 例临床分析. 中国骨肿瘤骨病, 2008, 7(4): 208-210.
22. Sailhan F, Chotel F, Parot R. Chondroblastoma of bone in a pediatric population. J Bone Joint Surg (Am), 2009, 91(9): 2159-2168.
23. Suneja R, Grimer RJ, Belthur M, et al. Chondroblastoma of bone: long-term results and functional outcome after intralesional curettage. J Bone Joint Surg (Br), 2005, 87(7): 974-978.
24. Tamura M, Oda M, Matsumoto I, et al. Chondroblastoma with pulmonary metastasis in a patient presenting with spontaneous bilateral pneumothorax: Report of a case. Surg Today, 2011, 41(10): 1439-1441.