涉及桡骨远端骨巨细胞瘤的外科手术疗效比较

目的：探讨和比较不同手术术式治疗涉及桡骨远端的骨肉瘤的手术适应症选择，临床疗效和安全性。方法：将2005 年-2014 年我院收治的涉及到桡骨远端并进行外科手术治疗的骨巨细胞瘤患者共88 例进行回顾性分析。根据影像学Campanacci分级，主 要手术方法分为以下三种，分别为：A组：微波天线高温原位灭活，自体髂骨，异体骨粒符合骨水泥重建修复术；B：瘤骨切除并腓 骨移植术；C：瘤骨刮除灭活并原位植骨术。结合详实的随访资料对两组患者在术后的复发率，腕关节功能（Enneking）等情况给予 分析和评价。结果：A 组复发率为10.87 %，腕关节功能MSTS93 功能评分为26.32± 2.92分。B 组复发率为0，腕关节术后的 MSTS93 功能评分为22.85± 4.16 分。C 组复发率为30.24 %。腕关节术后的MSTS93 功能评分为26.97± 2.84 分。三组相比，A、 B 与C 组在复发率中有明显统计学差异（P<0.05），A 组、C组的术后功能评分明显优于B 组（P<0.05），但两组之间无统计学差异 （P>0.05）。A 组中有1 例切口表层感染，B 组中有2 例皮肤感染，均经加强换药后治愈。结论：瘤段切除手术能够有效的降低复发 率，但局部功能恢复较差，容易出现切口感染等并发症。微波灭活手术可以有效的杀灭肿瘤组织并保证良好的功能性，但复发率 相对较高。在临床工作中应根据患者具体病情和需要给予针对性的手术方案。

Comparison of the Clinical Efficacy of Different Operations in the Treatment of Giant Cell Tumor in Distal Radius

Objective:To compare the clinical effect and safety of patients with giant cell tumor in distal radius treated with different operations.Methods:88 patients with giant cell tumor in distal radius who had surgical indications were involved. 3 major operations were used in the treatment according to the Campanacci grading system. Group A were treated with hyperthermia by inserted microwave antennas after tumor exposure in situ and the resulted bone defect were reconstructed with the compound including self-ilium, allogeneic bone powders and bone cement. Patients in group B underwent en bloc resection of bone tumor with autologous fibula. Patients in group C underwent curettage, adjuvant phenol therapy, and bone grafting. Clinical outcomes were evaluated by Enneking, and the cost, recurrence was compared between three groups.Results:The tumor recurred in 5 patients in group A with a recurrence rate of 10.87 %. According to the Enneking functional evaluation system, MSTS93 score was 26.32± 2.92. None people in B group had the recurrence and the MSTS93 score was 22.85± 4.16. The recurrence rate of group C was 33.33 % and MSTS93 score was 22.97± 3.84. There were significant statistical differences in recurrence rate between 3 groups (P<0.05). The functional score in A and C are significantly better than that in B group, while there was no significant statistical difference between A and C (P>0.05). There was 1 superficial infection in A group and 2 cases in B group, which were cured dressing.Conclusion:En bloc resection of bone tumor could reduce the recurrence rate while it had the poor function recovery and more risks of complications. Microwave-induced hyperthermia could kill the tumors completely and had better function recovery, but it had the great recurrence. The schedule of surgery should be done according to patients'' condition.