氩氦刀联合肿瘤病灶刮除植骨内固定术治疗胫骨近段骨巨细胞瘤疗效分析

Treatment of proximal tibial giant cell tumor with argon-helium knife combined with tumor curettage and bone grafting can improve knee function after operation

摘要:

目的 评价氩氦刀联合肿瘤病灶刮除植骨内固定术治疗胫骨近段骨巨细胞瘤对于术后膝关节功能 改善的影响。方法 选取2010 年1 月-2016 年12 月的23 例胫骨近段骨巨细胞瘤患者。其中，男性11 例，女12 例； 年龄16 ～ 39 岁，平均（25.8±9.1 岁）。依照不同治疗水平分为两组：单纯手术组11 例，男性5 例，女6 例； 年龄17 ～ 36 岁，平均26.5 岁；行肿瘤病灶刮除植骨内固定术。氩氦刀联合手术组12 例，男性6 例，女6 例； 年龄16 ～ 39 岁，平均28.1 岁；行氩氦刀联合肿瘤病灶刮除植骨内固定术。行标准化术后处理，记录各组并 发症情况，在第3、6 和12 个月采用美国特种外科医院（HSS）评分评价膝关节功能。结果 所有患者均获得 12 个月观察，两组患者间性别、年龄、体重、肿瘤Enneking 分级等一般资料差异无统计学意义（P >0.05）， 具有可比性。所有患者术后切口均一期愈合，单纯手术组术后下肢水肿1 例，小腿外侧皮神经损伤3 例，术后 第12 个月原位复发1 例。氩氦刀联合手术组术后1 例发生肺部感染，2 例发生小腿外侧皮神经损伤。不同时 间的HSS 膝关节功能评分有差异（F =91.264，P =0.000）；两组的术后HSS 膝关节功能评分有差异（F =41.411， P =0.000），氩氦刀联合手术组术后HSS 膝关节功能评分较高，相对恢复效果较好；两组的HSS 膝关节功能评分 变化趋势有差异（F =4.972，P =0.037）。结论 氩氦刀联合肿瘤病灶刮除植骨内固定术治疗胫骨近段骨巨细胞 瘤肿瘤可改善术后第3、6 和12 个月的膝关节功能。

Abstract:

Objective To evaluate the effect of argon-helium knife combined with tumor curettage, bone grafting and internal fixation for the treatment of proximal tibial giant cell tumor on improvement of postoperative knee joint function. Methods Twenty-three patients of proximal tibial giant cell tumor from January 2010 to December 2016 were retrospectively analyzed. Among them there were 11 males and 12 females with an average age of (25.8 ± 9.1) years (ranging from 16 to 39 years). According to different treatment levels all patients were divided into two groups. The simple operation group had 11 cases (5 males and 6 females), aged 17-36 years with an average of 26.5 years, and treated with tumor curettage, bone grafting and internal fixation. The argon-helium knife combined operation group had 12 cases (6 males and 6 females), aged 16-39 years with an average of 28.1 years, and treated with tumor curettage, bone grafting and internal fixation combined with argon-helium knife. After standardized treatment, the complications of each group were recorded, knee joint HSS function score was recorded 3, 6 and 12 months after operation. Results All patients were observed for 12 months, and there was no significant difference between the two groups in gender, age, weight, tumor Enneking class or preoperative HSS score (P > 0.05), and there was comparability between the two groups. All incisions healed at first stage. In the simple operation group, 1 case had lower limb edema, injury of lateral cutaneous nerve of leg occurred in 3 cases, and 1 case had recurrence in situ 12 months after operation. In the argon-helium knife combined operation group, 1 case had lung infection, and 2 cases suffered from injury of lateral cutaneous nerve of leg. The HSS knee function score was different at different time points (F = 91.264, P = 0.000). The HSS knee function score was different between the two groups (F = 41.411, P = 0.000); the postoperative HSS knee function score was higher, the relative recovery effect was better in the argonhelium knife group. The change trends of HSS knee function score were different between the two groups (F = 4.972, P = 0.037). Conclusions Argon-helium knife combined with tumor curettage, bone grafting and internal fixation for the treatment of proximal tibial giant cell tumor can improve the knee function at the 3rd, 6th and 12th month after operation.