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.
目的 觀察和評估活性多孔納米復合人工顆粒骨納米羥基磷灰石聚酰胺66（n-HA/PA66）骨修復下肢承重骨大塊良性腫瘤性骨缺損的臨床療效。 方法 選取2007年12月－2011年5月，良性骨腫瘤行股骨和脛骨手術術后骨缺損較大，需植骨填充且植骨量＞20 g的患者67例。其中骨巨細胞瘤26例，纖維結構不良18例，骨囊腫10例，其他良性骨腫瘤13例。腫瘤刮除后瘤腔大小為3.0 cm×2.0 cm×1.5 cm～7.0 cm×3.0 cm×3.0 cm。全部患者行病灶刮除、瘤腔滅活、大量打壓式植入n-HA/PA66人工骨，根據患者情況加用同種異體松質骨、含DBM人工骨，并根據皮質受累范圍及厚度選擇適當內固定。定期隨訪觀察傷口愈合情況、患者肝腎功能、免疫指標、關節活動度及植骨處愈合情況。 結果 67例患者全部獲得隨訪，隨訪時間7～45個月，平均31.3個月。所有患者傷口均I/甲愈合，術后無肝、腎功能損害，無免疫相關疾病發生。患者植骨愈合時間為術后3～9個月，平均4.6個月，愈合率95.2%。術后骨巨細胞瘤患者局部復發3例，均經再次手術，隨訪未再復發。 結論 n-HA/PA66顆粒骨可作為下肢承重骨大塊良性腫瘤性骨缺損的植骨填充材料。