Objective To discuss the definition of complicated giant cell tumor of the bone and retrospectively analyze the treatment protocols and their therapeutic results so as to provide a clinical basis for reducing the postoperative recurrence of this kind of tumor. Methods From April 2001 to April 2005, 22patients (11 males and 11 females, aged 15-66 years) with complicated giant cell tumor of the bone were treated by the marginal or wide excision. The tumor was located in the distal femur in 10 patients, the proximal tibia in 5, theproximal femur in 2, the proximal humerus in 2, the hip bone in 2, and the distal radius in 1. The Campanicci′s grading system was used and the patients were grouped as follows: Grade Ⅱ in 4 patients, and Grade Ⅲ in 18. The functional results of the patients were assessed by the clinical examination. The reconstruction methods were used in the forms of osteoarticular allografting (14 patients) and total arthroplasty (8 patients). Results The analysis on the follow-up (6-48 months, averaged 23 months) of the 22 patients revealedthat the complicated factors were as follows: the tumor breaking through the cortex with an extraosseous mass; the tumor having pathologic fracture; the tumor representing more biologically-aggressive lesions; and the tumor having one or more local recurrences. Two patients (9%) had a local recurrence respectively 8 and 11 months after operation, but improved respectively by limb amputation and radiotherapy. Total arthroplasty achieved a better articular function than osteoarticular allografting. All the patients with osteoarticular allografts showed various degrees of the bone union of the allograft with the host bone. Conclusion The marginal or wide excision of this kind of complicated giant cell tumor of the bone combined withosteoarticular allograft or total arthroplasty can reduce the local recurrence of the tumor and achieve a certain degree of the articular motion function.
ObjectiveTo explore whether FTY-720P could enhance the effect of allograft bone for bone defect repair by suppressing osteoclast formation and function. MethodAnimal experiment:Forty-eight New Zealand white rabbits were selected to establish the tibia defect model (1.5 cm in length) and were divided into 4 groups (n=12) . Defect was not repaired in group A, defect was repaired with allograft bone in group B, with autogenous fibula in group C, and with allograft bone and FTY-720P in group D. Lane-Sandhu scoring system and bone density examination were used to evaluate the effect at 2, 4, 8, and 12 weeks after operation. Cell experiment:Bone marrow-derived mononuclear phagocytes (BMMs) were harvested from 1-month-old Sprague Dawley rats and induced into osteoclasts with macrophage colony stimulating factor (M-CSF) and receptor activator of nuclear factor-κB ligand (RANKL), then were identified with tartrate-resistant acid phosphatas (TRAP). According to different concentrations of FTY-720P before induction, experiment was divided into 0, 500, 600, 700, 800, 900, 1 000, and 1 500 ng/mL groups. The effect of FTY-720P was studied by counting the number of osteoclasts and the number of bone resorption lacunae made by osteoclasts. ResultsAnimal experiment:Lane-Sandhu score showed no significant difference between groups at 2 weeks after operation (P>0.05) , but the score was significantly better in groups C and D than groups A and B, and in group B than group A (P<0.05) . The bone density of group C was significantly greater than that of groups A, B, and D at 2 weeks after operation (P<0.05) , but no significant difference was found among groups A, B, and D (P>0.05) ; the bone density of groups B, C, and D was significantly greater than that of group A at 4, 8, and 12 weeks (P<0.05) , but no significant difference was shown among groups B, C, and D (P>0.05) . Cell experiment:BMMs could be induced into osteoclasts by the addition of M-CSF and RANKL, which could be proved by counting the number of the nuclear and TRAP staining. The osteoclasts were significantly more in 0, 500, 600, 700, 800, 900 ng/mL groups than 1 000 and 1 500 ng/mL groups (P<0.05) , in 0, 500, 600, and 700 ng/mL groups than 800 and 900 ng/mL groups (P<0.05) , in 0, 500, 600 ng/mL groups than 700 ng/mL group (P<0.05) ; and there was no significant difference between the other groups (P>0.05) . The number of bone resorption lacunae in 0, 500, 600, and 700 ng/mL groups was significantly higher than that in 800, 900, 1 000, and 1 500 ng/mL groups (P<0.05) , and it was significantly higher in 0, 500 and 600 ng/mL groups than 700 ng/mL group (P<0.05) , but difference was not significant between the other groups (P>0.05) . ConclusionsFTY-720P combined with allograft bone for bone defect repair can have the same effect to autogenous bone by means of inhibiting osteoclast formation and function, which reduces bone loss.
From 1979, a total of 5 cases of giant cell tumor of the lower end of radius were treated by segmental resection, and vascularized fibular head transplantation, and reconstruction of the inferior radio-ulnar joint. The bone healed within 2-3 months. The patients were followed for 5-10 years. There was no recurrence, nor distant metastasis, and the functional recovery of extremities was satisfactory.The clinical materials, the operative techniques and the assessment of the long-term results were introduced.
To evaluate the effectiveness of tumor-segmental resection and autologous il iac bone graft reconstruction combined with internal fixation in treating hand-foot-giant cell tumor of bone. Methods Between August 1997 and April 2008, 8 cases of hand-foot-giant cell tumor of bone were treated, including 3 males and 5 females with an average age of 28.5 years (range, 16-42 years). The locations were metacarpal bones in 3 cases, metatarsal bones in 4 cases, and phalanges of toes in 1 case. According to Campanacci’s gradation of X-ray films, there were 1 case of grade I and 7 cases of gradeII; according to pathological examination before opration, there were 3 cases of grade I to II, 4 cases of grade II, and 1 case of grade II to III; and according to TNM staging, there were 1 case of TisN0M0, 4 cases of T1N0M0, and 3 cases of T2N0M0. There were 2 cases of recurrence, the time from the first operation to recurrence were 11 and 14 months, respectively. The tumor size was 1.8 cm × 1.0 cm to 6.0 cm × 2.0 cm, the cortical bone became thinner, and the boundary between tumor and periosteum was clear. All patients underwent tumor-segmental resection combined with autologous il iac bone graft reconstruction, and miniplate internal fixation by lumbar anesthesia or trachea cannula anesthesia. Results All incision healed by first intention. Eight patients were followed up 10 to 84 months with an average of 46 months. Radiographs showed that fracture union was achieved at 3 to 9 months (mean, 5 months). No significant rotation, angular, and shortening deformity occurred in il iac bone graft. The function of il iac bone donor site recovered excellently. The pathological examination showed giant cell tumor of bone in all cases, including 2 case of grade I-II, 5 cases of grade II, and 1 case of grade II-III. The hand or foot function recovered excellently. No tumor recurrence or lung metastasis occurred during follow-up. Conclusion Tumor-segmental resection combined with autologous il iac bone graft reconstruction plus internal fixation has excellent effectiveness for hand-foot-gaint cell tumor of bone.