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.
目的:明确脊柱骨巨细胞瘤的多层螺旋CT、MRI表现。方法:回顾性分析经病理证实的脊柱骨巨细胞瘤6例(男5例,女1例,年龄21～40岁,平均32岁)。6例CT检查,3例有MRI检查。结果:发生于胸椎3例,腰椎1例,骶椎2例。CT主要表现为膨胀性溶骨性破坏和较大软组织肿块;MRI表现T1加权成像为低等信号,T2加权成像为高低混杂信号特点,可显示瘤内坏死、囊变、出血等。结论:脊柱骨巨细胞瘤具有侵袭性强、生长活跃、易复发等特点,结合CT、MRI检查可对该病做出及时诊断,且对临床分期、手术方案制订及术后定期随访有重要价值。
Objective To analyze the clinical features, treatment methods, and recurrence factors of giant cell tumor of the bone and to investigate the surgical therapy choice for the tumor around the knees. Methods Thirty-eight patients (13 males and 25 females; average age 31.1 years, range 14-59 years) withgiant cell tumor of the bone were treated and followed up from January 1993 to January 2005. The patients’ diagnoses were established by biopsies of the specimens from the preoperative punctures or operations. The clinical features and the radiological and laboratory data from the 38 patients were reviewed. By the Campanicci’s radiological grading system, 5 patients were in Grade Ⅰ, 22 in GradeⅡ, and 11 in Grade Ⅲ. By the Enneking classification, 9 patients were in Grade Ⅰ, 21 in Grade Ⅱ, and 8 in Grade Ⅲ. By the Jaffe’s classification, 7 patients were in Grade Ⅰ, 24 in Grade Ⅱ, and 7 in Grade Ⅲ. The intralesional excision (curettage) with the bone grafting was performed on 4 patients; the curettagewith some adjuvant treatments (highspeed burring, phenol, alcohol, cement, hydrogen peroxide, 50％ ZnCl2, 3% iodine tincture, or bone cement) was used in 26 patients; and resection of the whole tumor was performed on 8 patients. Results The follow-up of the 38 patients for 12-144 months (average, 67 months) revealedthat giant cell tumor of the bone was found around the knees in 29 of the 38 patients (13 at the distal femur, 16 at the proximal tibia), at the proximal femurin 2, at the proximal ulna in 2, at the distal radius in 2, at the sacroiliac area in 2, and at lumbar spine in 1. Of the 38 patients, 4 had a recurrence after simple curettage, 8 had no recurrence after resection of the whole tumor, and 8 of the remaining 26 patients had a recurrence after curettage with some adjutant treatments. Five patients in Grade Ⅰ (Campanicci’s radiological grading) hadno recurrence, 6 of the 11 patients in Grade Ⅱ had a recurrence, and 6 of the 11 patients in Grade Ⅲ had a recurrence. Two of the 9 patients in Grade Ⅰ (Enneking grading) had a recurrence, 6 of the 21 patients in Grade Ⅱ had a recurrence, and 4 of the patients in Grade Ⅲ had a recurrence; all the recurrent lesions were around the knee, with a duration of the recurrence ranging from 2 months to 36 months (average,14.3 months). Of the patients with the recurrence, 12 underwent reoperations (8 by the total resection of the recurrent tumor, 4 by the curettage with adjuvant treatments), and there was no recurrence after the reoperation. Conclusion Giant cell tumor of the bone usually recurs around the knee joint, especially at the proximal tibia, usually graded as Grade Ⅱ or Ⅲ bythe Campanicci’s radiological grading system. Simple curettage has a higher recurrence rate; therefore, extensive curettage and resection of the lesions combined with some adjuvant treatments after the correct diagnosis can beused to reduce the high recurrence rate of giant cell tumor of the bone.
ObjectiveTo evaluate the effect of bone cement filling on articular cartilage injury after curettage of giant cell tumor around the knee. MethodsFifty-three patients with giant cell tumor who accorded with the inclusion criteria were treated between January 2000 and December 2011, and the cl inical data were retrospectively analyzed. There were 30 males and 23 females, aged 16-69 years (mean, 34.2 years). The lesion located at the distal femur in 28 cases and at the proximal tibia in 25 cases. According to Campanacci grade, there were 6 patients at grade I, 38 at grade Ⅱ, and 9 at grade Ⅲ. Of 53 patients, 42 underwent curettage followed by bone cement fill ing, and 11 received curettage followed by bone grafts in the subchondral bony area and bone cement fill ing. Two groups were divided according to whether secondary osteoarthritis occurred or not during postoperative follow-up. The gender, age, lesion site, the subchondral residual bone thickness, tumor cross section, preoperative Campanacci grade, subchondral bone graft, and Enneking function score were compared between 2 groups, and multivariate logistic regression analysis was done. ResultsAll incisions healed by first intention. The average follow-up time was 65 months (range, 23-158 months). Of 53 cases, 37 (69.8%) had no osteoarthritis, and 16 (30.2%) had secondary osteoarthritis. Three cases (5.7%) recurred during the follow-up period. Univariate logistic regression analysis showed no significant difference in gender, age, lesion site, and Campanacci grade between 2 groups (P>0.1); difference was significant in the subchondral residual bone thickness, tumor cross section, Enneking function score, and subchondral bone graft (P<0.1). The multivariate logistic regression analysis showed that the decreased subchondral residual bone thickness, the increased tumor cross section, and no subchondral bone graft are the risk factors of postoperative secondary osteoarthritis (P<0.05). ConclusionCurettage of giant cell tumor around the knee followed by bone cement filling can increase the damage of cartilage, and subchondral bone graft can delay or reduce cartilage injury.
In order to observe the curative effect and general reaction of locally used adriamycin (ADM)-loaded chitosan drug delivery system on giant cell tumor of bone after curettage. The cavities of 4 cases of giant cell tumor after curettage were filled with ADM-loaded chitosan drug delivery system with 4 times the dosage usually used for intravenous application. After operation, the concentration of ADM in plasma on the 1st, 2nd and 5th day, and the functions of liver and kidney on the 1st week, 1st month and 6th month were all investigated. The results were that the concentration of ADM in plasma was (143.05 +/- 27.55) ng/ml, (52.17 +/- 11.28) ng/ml and (4.25 +/- 3.07) ng/ml respectively, and the functions of liver and kidney were all normal in 6 months. After a follow-up of 7-19 months, no local or general reactions were observed and X-ray showed no recurrence. Therefore, it was concluded that the locally used ADM-loaded chitosan delivery system was safe and effective in treatment of giant cell tumor of bone after curettage.
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.
Objective To discuss the surgical selection and effectiveness for patients with recurrent giant cell tumor of bone. Methods Between February 1988 and June 2007, 79 patients with recurrent giant cell tumor of bone were treated. There were 42 males and 37 females, with a mean age of 33.1 years (range, 15-72 years). In primary surgery, 76 patients underwent intralesional curettage, and the other 3 patients underwent resection; the recurrence time was 2-176 months after primary surgery. The locations of tumor were upper extremities in 14 cases and lower extremities in 65 cases. According to Companacci grade, 1 case was at grade I, 33 cases at grade II, and 45 cases at grade III before primary surgery. In secondary operation, 37 patients underwent intralesional curettage and bone grafting combined with adjuvant inactivated, and 42 patients underwent wide resection. Results Bone allograft immune rejection occurred in 2 cases, which led to poor healing; primary healing of incision was obtained in the other patients. The patients were followed up 68 months on average (range, 18-221 months). Recurrence occurred in 12 patients at 6-32 months after operation. The re-recurrence rate was 24.3% (9/37) in cases of intralesional curettage and bone grafting combined with adjuvant inactivated, and they were given the wide resection. The re-recurrence rate was 7.1% (3/42) in cases of wide resection and they were amputated. There was significant difference in the re-recurrence rate between the intralesional curettage and the wide resection (χ2=4.508, P=0.034). No recurrence was observed during 3-year follow-up among re-recurrence patients. Conclusion For benign recurrent giant cell tumor of bone, intralesional curettage and bone grafting combined with adjunctive therapy could get an acceptable effectiveness, however, it has higher local recurrence than wide resection. For large tumor and recurrent malignant giant cell tumor of bone, wide resection is recommended.
Objective To study the method and effect of the vascularized fibular combined with iliac grafting after the tumor extensive resection for giant cell tumor of the bone around the knee. Methods Twenty-five patients with giantcell tumor of the bone around the knee were reviewed, who had been admitted to our hospital from October 1996 to November 2002, including 17 patients undergoing the fibular and iliac transplantation with the vessels anastomosed afterthe extensive excision of the bone tumor. By the surgicallystaged manner of Enneking, all the patients were grouped in the stage of ⅠA; by the Campanicci’s radioactive image staging, 11 patients were grouped in stage Ⅰ, 5 in stage Ⅱ, and 1 in stage Ⅲ; by the Jaffe’s pathological staging, 9 patients were grouped in stage Ⅰ, 7 in stage Ⅱ, and 1 in stage Ⅲ. Of the patients, 9 were treated by the vascularized fibular combined with iliac grafting in the proximal tibia after the tumor extensive resection, and 8 were treated by the distal femur reconstruction by the operation. The following items were also analyzed: postoperativeinfection, growth of the bone graft, rate of local recurrence, tumor metastasis, and bone death. The function of the knee joint was evaluated. Results According the follow-up of the 17 patients for 26-87 months (mean, 54 months), all thebone graft healed well within 75-120 days (mean, 93 days) after operation. Twopatients had a local recurrence and 3 had a mildly-narrowed joint. The flexion and extension function of the knee joint recovered, with a range of motion of thereconstructed distal femur of 80°-105° (mean, 96°) while the proximal tibia had a range of motion of 90-120° (mean, 110°). The functional outcome wasexcellent in 11 patients, good in 3 patients, fair in 1 patient, and bad in 2 patients,with a total satisfactory rate of 82.4%. Conclusion The vascularized fibular combined with iliac grafting after the tumor extensive resection to treat giant cell tumor of the bone around the knee has advantages of complete resection of the tumor and well-restored or reconstructed structure and function of the knee joint.