Objective To discuss the surgical selection and effectiveness for patients with recurrent giant cell tumor of bone. Methods Between February 1988 and June 2007, 79 patients with recurrent giant cell tumor of bone were treated. There were 42 males and 37 females, with a mean age of 33.1 years (range, 15-72 years). In primary surgery, 76 patients underwent intralesional curettage, and the other 3 patients underwent resection; the recurrence time was 2-176 months after primary surgery. The locations of tumor were upper extremities in 14 cases and lower extremities in 65 cases. According to Companacci grade, 1 case was at grade I, 33 cases at grade II, and 45 cases at grade III before primary surgery. In secondary operation, 37 patients underwent intralesional curettage and bone grafting combined with adjuvant inactivated, and 42 patients underwent wide resection. Results Bone allograft immune rejection occurred in 2 cases, which led to poor healing; primary healing of incision was obtained in the other patients. The patients were followed up 68 months on average (range, 18-221 months). Recurrence occurred in 12 patients at 6-32 months after operation. The re-recurrence rate was 24.3% (9/37) in cases of intralesional curettage and bone grafting combined with adjuvant inactivated, and they were given the wide resection. The re-recurrence rate was 7.1% (3/42) in cases of wide resection and they were amputated. There was significant difference in the re-recurrence rate between the intralesional curettage and the wide resection (χ2=4.508, P=0.034). No recurrence was observed during 3-year follow-up among re-recurrence patients. Conclusion For benign recurrent giant cell tumor of bone, intralesional curettage and bone grafting combined with adjunctive therapy could get an acceptable effectiveness, however, it has higher local recurrence than wide resection. For large tumor and recurrent malignant giant cell tumor of bone, wide resection is recommended.
目的 观察和评估活性多孔纳米复合人工颗粒骨纳米羟基磷灰石聚酰胺66（n-HA/PA66）骨修复下肢承重骨大块良性肿瘤性骨缺损的临床疗效。 方法 选取2007年12月－2011年5月，良性骨肿瘤行股骨和胫骨手术术后骨缺损较大，需植骨填充且植骨量＞20 g的患者67例。其中骨巨细胞瘤26例，纤维结构不良18例，骨囊肿10例，其他良性骨肿瘤13例。肿瘤刮除后瘤腔大小为3.0 cm×2.0 cm×1.5 cm～7.0 cm×3.0 cm×3.0 cm。全部患者行病灶刮除、瘤腔灭活、大量打压式植入n-HA/PA66人工骨，根据患者情况加用同种异体松质骨、含DBM人工骨，并根据皮质受累范围及厚度选择适当内固定。定期随访观察伤口愈合情况、患者肝肾功能、免疫指标、关节活动度及植骨处愈合情况。 结果 67例患者全部获得随访，随访时间7～45个月，平均31.3个月。所有患者伤口均I/甲愈合，术后无肝、肾功能损害，无免疫相关疾病发生。患者植骨愈合时间为术后3～9个月，平均4.6个月，愈合率95.2%。术后骨巨细胞瘤患者局部复发3例，均经再次手术，随访未再复发。 结论 n-HA/PA66颗粒骨可作为下肢承重骨大块良性肿瘤性骨缺损的植骨填充材料。