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【疾病名】骨巨细胞瘤【英文名】giant cell tumor of bone【缩写】【别名】osteoclastoma；破骨细胞瘤【ICD号】D48.0【概述】骨巨细胞瘤(giant cell tumor of bone，GCTB) 是常见的原发性骨肿瘤之一。
是由骨髓间质细胞分化而来的，以单核细胞为主要成分的溶骨性肿瘤，又称破骨细胞瘤(osteoclastoma)。
骨巨细胞瘤是骨的良性病变，通常单发并且有局部侵袭性。
也有人认为骨巨细胞瘤是一种潜在恶性的肿瘤。
此肿瘤既非完全良性，也非完全恶性，而是介于这两个极端之间，其侵袭程度表现不一，有的巨细胞瘤经过相对简单的手术就可获得长久的控制，而有的巨细胞瘤却可出现播散转移。
对具体的巨细胞瘤患者而言，通过分析其临床、影像和组织学表现来判断预后是很困难的，并且也是很不确定的。
自Jaffe于1940年首次描述该肿瘤以来，对其认识不断深化：该肿瘤具有较强侵蚀性，对骨质有很大溶蚀破坏作用，但极少有反应性新骨生成及自愈倾向；可穿过骨皮质形成较大的软组织包块；采用通常的刮除法复发率甚高；少数病例可出现局部恶性变或肺转移，但肺转移灶常生长缓慢甚至不需要治疗，即所谓良性转移(benign metastasis)。
基于上述特征，多数学者将其列为低度恶性或潜在恶性的肿瘤。
美国骨骼肌肉肿瘤学会1980年提出的骨肿瘤外科分期系统(surgical staging system)中，将骨巨细胞瘤正式列为低度恶性肿物。
【流行病学】根据西方国家的统计资料，骨巨细胞瘤并不多见。
据美国统计约占全部骨骼肌肉系统肿瘤的10%，中国发病率较西方国家为高，占骨肿瘤的14%～16%。
骨巨细胞瘤最常见于20～40岁，另一个高峰年龄为55～65岁，不到10%的骨巨细胞瘤发生于未成熟骨，发病率无性别差异。
骨巨细胞瘤的原发部位几乎都发生在骨骺，随着病灶的扩大逐渐侵及干骺端。
假如病变局限于干骺端而不波及骨骺，骨巨细胞瘤的诊断几乎不能成立。
Advances in Clinical Medicine 临床医学进展, 2020, 10(4), 599-606Published Online April 2020 in Hans. /journal/acmhttps:///10.12677/acm.2020.104094Observation of Curative Effect ofLesion Scraping, Inactivation,Bone Cement Filling, and PlateInternal Fixation on Giant CellTumor of BoneJianbing Niu, Hao Chen, Lin Li, Kai Gao*Department of Orthopedics, Jining First People’s Hospital, Jining ShandongReceived: Apr. 5th, 2020; accepted: Apr. 20th, 2020; published: Apr. 27th, 2020AbstractObjective: To observe the clinical efficacy of tumor curettage, inactivation, bone cement filling, and plate internal fixation for giant cell tumor of distal femur. Methods: Fifty patients with giant cell tumors of the distal femur of our hospital were selected as the research subjects. All the subjects underwent tumor curettage, inactivation, bone cement filling, and plate internal fixation. Obser-vation of imaging date, knee muscle strength muscles, knee flexion and extensionbefore and after surgery, recurrence rate, and malignancy rate, is to verify theclinical efficacy of tumor curettage, inactivation, bone cement filling, and plate internal fixation for patients with giant cell tumor of bone. Results: After 5 years of follow-up, we observed no tumor recurrence at the tumor site from imaging. The bone cement was completely filled, the position of the plate internal fixation was good, bone cement did not fall off, and the internal fixation of the steel plate did not shift. At the same time, we found that the muscle strength of the patient reached a similar level of preoperative muscle strength at 1 month postoperatively, and the active flexion of the knee joint reached a sim-ilar level before surgery at 3 months postoperatively, and the flexion and extension activities were good. During our follow-up, we found that only one patient had a recurrence at 3 years after sur-gery, and the recurrence was at the original surgical site. We performed custom-made tumor prosthesis + joint replacement after distal femoral resection, and no recurrence had been ob-served since the follow-up. At the same time, in all of our surgical patients with giant cell tumor of bone, we did not find malignant changes after postoperative, all recovered well, and the excellent and good rate reached 98%. Conclusion: Tumor lesion scraping, inactivation, bone cement filling, and plate internal fixation have obvious clinical effects in treating giant cell tumor of distal femur.The patient’s affected limb muscle strength and knee flexion and extension can be recovered well, the patient can move early, and at the same time, the recurrence rate and malignant rate of the pa-tient can be significantly reduced, and the quality of life of the patient can be improved. It has good social and economic benefits and is worthy of application and promotion.*通讯作者。
骨软骨瘤手术是一种常见的骨科手术，主要用于治疗良性骨肿瘤。
以下是骨软骨瘤手术的详细步骤：
1.麻醉：根据患者的具体情况和手术范围，选择适当的麻醉方式，如局部麻醉、全身麻醉等。
2.体位：将患者放置在适当的体位上，一般采用仰卧位。
3.切口：在手术部位做一个切口，长度根据肿瘤的大小和位置而定。
4.显露肿瘤：通过切口剥离肌肉和筋膜，暴露出肿瘤所在的骨组织。
5.切除肿瘤：使用骨凿或刮匙将肿瘤从骨组织上彻底切除。
如果肿瘤较大，需要切除较多的骨组织，需要进行植骨或人工关节置换等手术。
6.缝合伤口：将切开的肌肉和筋膜逐层缝合，用无菌敷料包扎手术部位。
7.术后处理：观察患者的恢复情况，定期进行复查和换药，确保伤口愈合良好。
在手术过程中，需要注意以下几点技巧：
1.彻底切除肿瘤：要确保将肿瘤组织彻底切除，避免残留，否则可能导致复发。
2.保护周围组织：在剥离肌肉和筋膜时，要尽量保护周围的神经、血管等组织，避免损伤。
3.止血：在手术过程中要采取有效的止血措施，避免出血过多，影响手术效果和患者的健康。
4.缝合技巧：在缝合伤口时，要选择适当的缝合方式和缝合材料，确保伤口愈合良好，避免感染和术后并发症的发生。
总之，骨软骨瘤手术需要熟练掌握手术技巧和注意事项，确保手术安全、有效地进行。
Advances in Clinical Medicine 临床医学进展, 2020, 10(7), 1324-1329Published Online July 2020 in Hans. /journal/acmhttps:///10.12677/acm.2020.107200Analysis of 22 Cases of Giant Cell Tumor ofBone Treated by Enlarged Curettage andBone Cement Filling and Bone Grafting and Internal FixationXiangxiang Huo*, Jun Liu#, Zhibin Liu, Yanxiong Liu, Shenshen HaoDepartment of Spinal Surgery, Affiliated Hospital of Yan’an University, Yan’an ShaanxiReceived: Jun. 28th, 2020; accepted: Jul. 9th, 2020; published: Jul. 16th, 2020AbstractObjective: Because Giant cell tumor of bone is extremely rare, this time, 22 cases of lower limb giant cell tumor in our hospital were analyzed to evaluate the curative effect of enlarged focus cu-rettage and bone cement filling and bone grafting internal fixation in the treatment of giant cell tumor of bone, and to discuss the latest treatment progress of giant cell tumor of bone. Methods: From January 2015 to January 2020, 22 patients with giant cell tumor of lower limbs were admit-ted to the Department of Orthopaedics, Affiliated Hospital of Yan’an University, including 5 males and 17 females, including 13 cases of giant cell tumor of distal femur and 9 cases of giant cell tu-mor of proximal tibia. All patients and their families agreed to the operation, signed the informed consent form of the operation, and performed enlarged lesion scraping and bone cement filling and bone grafting internal fixation. Operation time, intraoperative blood loss, Visual analogue scale (VAS) scoring standard before and one month after operation, and MSTS scoring standard were observed. Results: The operation time of 22 patients was (93.55 ± 14.82) min, the blood loss during operation was (257.72 ± 73.73) ml, VAS scores (6.95 ± 1.05) and (1.91 ± 0.75) before and 1 month after operation, MSTS scores (10.32 ± 2.82) and (26.32 ± 1.55) before and 1 month after operation, respectively. All patients were followed up for 6 to 60 months. Among 22 patients, 2 pa-tients relapsed within 1 to 2 years after operation, with a recurrence rate of about 9.1%, while the rest patients did not relapse during observation. Conclusion: Prognosis and recurrence of giant cell tumor of bone are closely related to surgical methods. Although curettage of enlarged lesion and bone cement filling and bone grafting and internal fixation are not as thorough as re-section of tumor segment, but the operation method can not only greatly reduce the recurrence rate but also preserve the limb function of patients to the greatest extent considering the patient’s own factors.KeywordsScaling up Lesions for Curettage, Giant Cell Tumor of Bone, Bone Cement Packing, Internal Fixation*第一作者。
骨巨细胞瘤的治疗：（附58例报告）韦正超;赵春和【期刊名称】《广东医学》【年(卷),期】1994(015)002【摘要】骨巨细胞瘤是一种常见的潜在恶性骨肿瘤。
1973年Marcve等报告用冷冻方法治疗骨巨细胞瘤,后来不少学者报告应用95％酒精、石碳酸及50％氧化锌灭活等方法治疗骨巨细胞瘤,效果较为满意。
我科于1984年以来应用冷冻及酒精灭活方法共治疗骨巨细胞瘤58例,效果较为满意,现报告如下。
临床资料性别和年龄:男37例,女21例,年龄最小10岁,最大60岁。
年龄10岁～34例,20岁～19例,40岁以上5例。
发生部位:股骨下端18例,胫骨上端26例,肱骨上端10例,桡骨下端4例。
临床症状:大部分病人有不同程度的局部隐痛、疼痛及肿胀,局部变形,下肢患者有明显的跛行。
病理所见及分类:肉眼见肿瘤组织为软而脆的肉芽组织,无包膜,循环旺盛,肿瘤组织因出血机化及色素沉着,切面呈枣红、桔红或桔黄色。
【总页数】2页(P108-109)【作者】韦正超;赵春和【作者单位】不详;不详【正文语种】中文【中图分类】R738.105【相关文献】1.瘤段切除带血管蒂腓骨移植融合膝关节治疗胫骨上段骨巨细胞瘤(附四例报告) [J], 余泉生;宋勇;廖小平;谢克达2.病灶切刮骨水泥植入术治疗胫骨上端骨巨细胞瘤(附1 5例报告) [J], 张海波;宋占华;张培勋3.异体骨移植与人工假体治疗骨巨细胞瘤的疗效比较(附56例报告) [J], 张卫东4.骨巨细胞瘤的冷冻手术治疗(附48例报告) [J], 郭士方;郭万民;郭世元;黄义昌;尚淑琴;周九珍5.颞骨巨细胞瘤的诊断与治疗(附1例报告) [J], 王延升;李学昌;张晓燕;张玉莉;刘清明因版权原因，仅展示原文概要，查看原文内容请购买。
