目的探讨四肢骨巨细胞瘤术后复发患者再次手术术式选择及疗效。方法回顾1988年2月-2007年6月收治且获完整随访的79例骨巨细胞瘤术后复发再次手术患者临床资料。男42例,女37例;年龄15～72岁,平均33.1岁。初次行囊内刮除76例,整块切除3例;初次手术后2～176个月肿瘤局部复发。肿瘤病灶位于上肢14例,下肢65例。初次手术前影像学Companacci分级,Ⅰ级1例、Ⅱ级33例、Ⅲ级45例。再次手术37例采用囊内刮除植骨联合辅助灭活,42例采用肿瘤整块切除治疗。结果术后2例出现同种异体骨免疫排斥反应,导致切口不愈合;余患者切口均Ⅰ期愈合。患者均获随访,随访时间18～221个月,平均68个月。其中12例于术后6～32个月局部再次复发,采用囊内刮除植骨联合辅助灭活措施者中再复发9例(24.3%,9/37),均再次行肿瘤整块切除;肿瘤整块切除再复发3例(7.1%,3/42),均截肢;两种术式复发率比较差异有统计学意义(χ2=4.508,P=0.034);再复发患者术后随访3年均未见复发。结论复发性四肢骨巨细胞瘤可以通过囊内刮除植骨联合辅助灭活治疗,但肿瘤局部复发率高于肿瘤整块切除。对于肿瘤范围超过横断面50%预测不能彻底刮除及恶性复发性骨巨细胞瘤患者,建议采用肿瘤整块切除方法。 Objective To investigate the surgical options and curative effect of patients with recurrent giant cell tumor of the limbs after surgery. Methods The clinical data of 79 patients with recurrent giant cell tumor of bone after resection and complete follow-up from February 1988 to June 2007 were reviewed retrospectively. 42 males and 37 females; aged 15 to 72 years, an average of 33.1 years old. In the first intracapsular curettage and removal of 76 cases, the whole block in 3 cases; 2 to 176 months after the initial operation of tumor recurrence. Tumor lesions were located in 14 cases of upper extremity and 65 cases of lower extremity. Companacci imaging before the first operation, grade Ⅰ in 1 case, grade Ⅱ in 33 cases, grade Ⅲ in 45 cases. 37 cases of reoperation with intramedullary curettage in addition to bone graft assisted inactivation, 42 cases of tumor resection treatment. Results Allograft immune rejection occurred in 2 cases after operation, which resulted in nonunion of the incision. All wounds were healed in the first stage. All patients were followed up for 18 ~ 221 months with an average of 68 months. Among them, 12 cases relapsed locally 6 to 32 months after operation, and 9 cases (24.3%, 9/37) relapsed again by means of intracapsular curettage and bone graft combined with auxiliary inactivation measures. Three cases (8.1%, 3/42) had resection of the tumor, all of them were amputated. There was significant difference in the recurrence rate between the two operations (χ2 = 4.508, P = 0.034). The recurrence was followed up for 3 years No recurrence. Conclusions The recurrent limb giant cell tumor can be treated by intracapsular curettage and bone grafting combined with assisted inactivation. However, the local recurrence rate of tumor is higher than that of tumor mass excision. For tumors over 50% of the cross-section predicted not completely curettage and malignant recanalization of giant cell tumor of the human brain, the proposed method of tumor resection.