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目的回顾性分析两种不同的微波灭活技术应用于肢体骨巨细胞瘤的手术方法,观察手术疗效,从而找出一种更加安全有效的应用微波治疗肢体骨巨细胞瘤的手术方法。方法 2006年9月至2010年9月,21例肢体骨巨细胞瘤的患者在我院接受手术治疗,其中原发病例18例,复发3例(均为局部复发,未发现远处转移)。病变部位股骨8例,胫骨5例,肱骨5例,桡骨2例,尺骨1例。肿瘤伴发病理性骨折3例。8例行肿瘤原位微波灭活刮除术,即先行肿瘤原位微波灭活后刮除肿瘤;13例行肿瘤囊内刮除微波辅助残腔灭活术,即先采用常规的方法刮除肿瘤后,辅助以微波灭活肿瘤刮除术后的残腔。全部病例均得到病理学证实。结果全部患者均得到随访,平均随访时间23个月。各有1例肿瘤微波原位灭活刮除及肿瘤刮除微波辅助残腔灭活的病例,术后10个月及18个月局部复发。2例股骨远端病例及1例胫骨近端病例在术后6-12个月内发生骨折,均为肿瘤原位微波灭活刮除病例。无伤口并发症及深部感染的发生,无远处转移。术后MSTS功能评分微波原位灭活刮除组平均为24分,囊内刮除辅助微波灭活组平均为28分,全部微波灭活治疗的病例平均为26分。结论微波灭活技术是一种有效的治疗肢体骨巨细胞瘤的手术方法,可以获得较满意的术后局部复发率。肿瘤囊内刮除微波辅助残腔灭活术在保持局部低复发率的基础上,进一步降低了微波灭活术后骨折的发生率。
Objective To retrospectively analyze two surgical methods of microwave inactivation applied to giant cell tumor of the limbs and to observe the curative effect of the operation so as to find out a safer and more effective method for the treatment of giant cell tumor of the limb with microwave. Methods From September 2006 to September 2010, 21 patients with giant cell tumor of the limbs underwent surgery in our hospital. Among them, 18 cases were primary and 3 cases were recurrence (both local recurrence and distant metastasis were not found). Lesions in 8 cases of femur, tibia in 5 cases, 5 cases of humerus, radial in 2 cases, ulnar in 1 case. Tumor accompanied by pathological fracture in 3 cases. 8 cases of tumor in-situ microwave inactivation curettage, in-line microwave in situ tumor in-situ microwave curettage of tumors; 13 cases of tumor cyst curettage of microwave-assisted residual inactivation, that is to use the conventional method of curettage After the tumor, assisted by microwave inactivation of residual tumor after curettage. All cases were pathologically confirmed. Results All patients were followed up for an average of 23 months. One case of in-situ microwave in-situ curettage and tumor scraping microwave-assisted residual inactivation of the tumor cases, each local recurrence 10 months and 18 months after surgery. Two cases of distal femur and one case of proximal tibia fractured within 6-12 months after operation, all of which were in situ in-situ microwave inactivated cases. No wound complications and deep infection, no distant metastasis. The postoperative MSTS score was 24 on average in the in-situ in-situ curettage group and 28 on the intracranial curettage assisted microwave inactivation group, with an average of 26 points for all microwave inactivation treatments. Conclusion Microwave inactivation technique is an effective surgical treatment of giant cell tumor of the limbs, which can achieve satisfactory postoperative local recurrence rate. Oncology curettage of microwave-assisted residual inactivation on the basis of maintaining a low local recurrence rate, further reducing the incidence of microwave inactivation of the fracture.