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頁籤選單縮合
題 名 | Treatment of Giant Cell Tumor of Long Bone=長骨巨大細胞瘤治療 |
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作 者 | 施信農; 陳永仁; 黃聰仁; 何為斌; 薛綏 ; 許文蔚; | 書刊名 | 長庚醫學 |
卷 期 | 19:1 1996.03[民85.03] |
頁 次 | 頁16-23 |
分類號 | 416.66 |
關鍵詞 | 治療; 巨大細胞瘤; 骨; Treatment; Giant cell tumor; Bone; |
語 文 | 英文(English) |
中文摘要 | 長庚紀念醫院自1981年至1991年,總共治療並追?六十八位長骨巨大細胞瘤的患者。其中33名男性,35名女性;年齡介於14到76歲(平均32歲)。追?時間平均3.5年(2.5年至86個月)。17例分級為第二期,51例為第三期。發生的部位分肱骨近端4例、橈骨遠端11例、尺骨遠端1例、股骨遠端28例、頸骨近端18例、腓骨近端6例。45例發性,23例為復發性。二種主要方法,刮除術與廣性切除術。併發症包括九例局部復發、一例局部發炎、三例固定部位骨折、一例腳長不等、一例暫時性神經麻痺。 局部復發率佔所有手術病例之百分之十三。全部發生於施行刮除術之手術方法;十九例使用此法之患者有九例發(百分之四十七)。平均發時間約術後10.4個月。1989年以前九例有八例再發。1989年以後十例有一例再發。其原因在手術應廣泛開窗,刮除,磨骨與酚劑使用,並且其步驟均要徹底。在四十五例原發病變中,十三例為第二期,三十二例為第三期。十三例第二期中,有九例接受刮除術,但有四例再發。三十二例第三期中,有十例接受刮除術,但有五例再發。九例發之患者有七例接受切除術合併骨移植重建,經短時間之追?其結果良好。又所有手術病例中,一例在術後半年發生肺轉移,經化學治療後迄今仍存活。所有病例中,百分之八十五可達良好的結果。術前檢查及評估非常重要,對於轉小局限病灶,可考慮刮除。如果病灶較大,廠壞力較強,並有柔軟組侵犯時,宜考慮作根除手術。 |
英文摘要 | From 1981 to 1991, sixty-eight patients with giant cell tumors of their long bones were treated and followed-up at Chang Gung Memorial Hospital. Thirty-three males and thirty-five females between the ages of 14 and 76 (average, 32 years) were follower for an average duration of 3.5 years (range, 25 years to 7.3 years). Forty-five primary lesions and 23 cases for recurrent lesions were diagnosed. Seventeen patients were classified as grade II while 51, as grade III. Surgical procedures included Intralesional curettage and wide resection. The local recurrent rate following surgery was 13% (9/68). The overall outcome was 85% (58/68) good or excellent results. Complications included one superficial infection, 9 local recurrences and 3 fractures of fixation devices. In addition, one patient with a lung metastasis was noted. In the primary lesion group, there was 9 grade II and 10 grade III lesions treated by curettage and grafting. Of these 4 grade II and 5 Grade III patients had local recurrences. The recurrent rate was 47% (9/19) following intralesional curettage with a lung metastasis was noted. In the primary lesion group, there was 9 grade II and 10 grade III lesions treated by curettage and grafting. Of these 4 grade II and 5 grade III patients had local recurrences. The recurrent rate was 47% (9/19) following intralesional curettage with cancellous bone graft (8/16) or bone cement (1/3). The average period before local recurrence was 10.4 months. Seven of the 9 recurrent patients received radical resections and allograft reconstruction with good results at short-term followed-up. The other two patients were lost in follow-up. The cases in the curettage group had shown low recurrent rate (1/10) after 1989 and high recurrent rate (8/9) before 1989 (p<0.001). The most important factor for local recurrence appeared to be inadequate curettage with similar recurrence rates regardless of the type of bone graft used. A careful approach to the surgical margin including use of a dental burr and local adjuvant treatment with phenol, the rate of local recurrence may be decreased. There were no recurrences in the wide resection group. Although radical resection yield a best chance for cure, the sacrifice of the joint with subsequent arrthroplasty resulted a compromise of the joint function. |
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