To evaluate the effectiveness of tumor-segmental resection and autologous il iac bone graft reconstruction combined with internal fixation in treating hand-foot-giant cell tumor of bone. Methods Between August 1997 and April 2008, 8 cases of hand-foot-giant cell tumor of bone were treated, including 3 males and 5 females with an average age of 28.5 years (range, 16-42 years). The locations were metacarpal bones in 3 cases, metatarsal bones in 4 cases, and phalanges of toes in 1 case. According to Campanacci’s gradation of X-ray films, there were 1 case of grade I and 7 cases of gradeII; according to pathological examination before opration, there were 3 cases of grade I to II, 4 cases of grade II, and 1 case of grade II to III; and according to TNM staging, there were 1 case of TisN0M0, 4 cases of T1N0M0, and 3 cases of T2N0M0. There were 2 cases of recurrence, the time from the first operation to recurrence were 11 and 14 months, respectively. The tumor size was 1.8 cm × 1.0 cm to 6.0 cm × 2.0 cm, the cortical bone became thinner, and the boundary between tumor and periosteum was clear. All patients underwent tumor-segmental resection combined with autologous il iac bone graft reconstruction, and miniplate internal fixation by lumbar anesthesia or trachea cannula anesthesia. Results All incision healed by first intention. Eight patients were followed up 10 to 84 months with an average of 46 months. Radiographs showed that fracture union was achieved at 3 to 9 months (mean, 5 months). No significant rotation, angular, and shortening deformity occurred in il iac bone graft. The function of il iac bone donor site recovered excellently. The pathological examination showed giant cell tumor of bone in all cases, including 2 case of grade I-II, 5 cases of grade II, and 1 case of grade II-III. The hand or foot function recovered excellently. No tumor recurrence or lung metastasis occurred during follow-up. Conclusion Tumor-segmental resection combined with autologous il iac bone graft reconstruction plus internal fixation has excellent effectiveness for hand-foot-gaint cell tumor of bone.
Objective To observe the effectiveness of wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor. Methods Between March 2000 and March 2009, 31 cases of distal radius giant cell tumor were treated with extended resection and vascularized fibular head graft for repairing defects of the distal radius, and reconstructing wrist joint. There were 14 males and 17 females with an average age of 37.2 years (range, 15-42 years). The disease duration ranged from 1 month to 2 years and 3 months with an average of 8 months. The size oftumor was 6.5 cm 3.5 cm-8.0 cm 4.5 cm. The range of motion (ROM) of wrist joint was as follows: extension 5-15° (mean, 10.7°), flexion 9-21° (mean, 14.2 ), radial incl ination 0-10 (mean, 8.6 ), and ulnar incl ination 0-15° (mean, 7.9°). The ROM of forearm was as follows: pronation 15-50 (mean, 28.7 ) and supination 10-25° (mean, 16.5°). The histopathological examination revealed that there were 5 cases of stage I, 17 of stage II, and 9 of stage III. Results All patients achieved primary heal ing of incision and were followed up 1-9 years with an average of 4.5 years. The X-ray films showed that bone heal ing time was 12-16 weeks with an average of 13 weeks. No tumors recurrence was observed. The ROM of wrist joint was as follows at 1 year after operation: extension 20-50 (mean, 29.0 ), flexion 30-50° (mean, 35.0°), radial incl ination 10-20° (mean, 16.5°), and ulnar incl ination 20-25 (mean, 23.5 ). The ROM of forearm was as follows: pronation 40-90° (mean, 68.3°) and supination 30-80 (mean, 59.6 ). There were significant differences in the ROM between before operation and after operation (P lt; 0.05). According to the Krimmer et al wrist score, the results were excellent in 17 cases, good in 12, and fair in 2. Conclusion Wrist joint reconstruction with vascularized fibular head graft can restore function of wrist joint. The operation is proved to be safe and effective in treating distal radius giant cell tumor.
Objective To study the method and effect of the vascularized fibular combined with iliac grafting after the tumor extensive resection for giant cell tumor of the bone around the knee. Methods Twenty-five patients with giantcell tumor of the bone around the knee were reviewed, who had been admitted to our hospital from October 1996 to November 2002, including 17 patients undergoing the fibular and iliac transplantation with the vessels anastomosed afterthe extensive excision of the bone tumor. By the surgicallystaged manner of Enneking, all the patients were grouped in the stage of ⅠA; by the Campanicci’s radioactive image staging, 11 patients were grouped in stage Ⅰ, 5 in stage Ⅱ, and 1 in stage Ⅲ; by the Jaffe’s pathological staging, 9 patients were grouped in stage Ⅰ, 7 in stage Ⅱ, and 1 in stage Ⅲ. Of the patients, 9 were treated by the vascularized fibular combined with iliac grafting in the proximal tibia after the tumor extensive resection, and 8 were treated by the distal femur reconstruction by the operation. The following items were also analyzed: postoperativeinfection, growth of the bone graft, rate of local recurrence, tumor metastasis, and bone death. The function of the knee joint was evaluated. Results According the follow-up of the 17 patients for 26-87 months (mean, 54 months), all thebone graft healed well within 75-120 days (mean, 93 days) after operation. Twopatients had a local recurrence and 3 had a mildly-narrowed joint. The flexion and extension function of the knee joint recovered, with a range of motion of thereconstructed distal femur of 80°-105° (mean, 96°) while the proximal tibia had a range of motion of 90-120° (mean, 110°). The functional outcome wasexcellent in 11 patients, good in 3 patients, fair in 1 patient, and bad in 2 patients,with a total satisfactory rate of 82.4%. Conclusion The vascularized fibular combined with iliac grafting after the tumor extensive resection to treat giant cell tumor of the bone around the knee has advantages of complete resection of the tumor and well-restored or reconstructed structure and function of the knee joint.
Objective To analyze the clinical features, treatment methods, and recurrence factors of giant cell tumor of the bone and to investigate the surgical therapy choice for the tumor around the knees. Methods Thirty-eight patients (13 males and 25 females; average age 31.1 years, range 14-59 years) withgiant cell tumor of the bone were treated and followed up from January 1993 to January 2005. The patients’ diagnoses were established by biopsies of the specimens from the preoperative punctures or operations. The clinical features and the radiological and laboratory data from the 38 patients were reviewed. By the Campanicci’s radiological grading system, 5 patients were in Grade Ⅰ, 22 in GradeⅡ, and 11 in Grade Ⅲ. By the Enneking classification, 9 patients were in Grade Ⅰ, 21 in Grade Ⅱ, and 8 in Grade Ⅲ. By the Jaffe’s classification, 7 patients were in Grade Ⅰ, 24 in Grade Ⅱ, and 7 in Grade Ⅲ. The intralesional excision (curettage) with the bone grafting was performed on 4 patients; the curettagewith some adjuvant treatments (highspeed burring, phenol, alcohol, cement, hydrogen peroxide, 50％ ZnCl2, 3% iodine tincture, or bone cement) was used in 26 patients; and resection of the whole tumor was performed on 8 patients. Results The follow-up of the 38 patients for 12-144 months (average, 67 months) revealedthat giant cell tumor of the bone was found around the knees in 29 of the 38 patients (13 at the distal femur, 16 at the proximal tibia), at the proximal femurin 2, at the proximal ulna in 2, at the distal radius in 2, at the sacroiliac area in 2, and at lumbar spine in 1. Of the 38 patients, 4 had a recurrence after simple curettage, 8 had no recurrence after resection of the whole tumor, and 8 of the remaining 26 patients had a recurrence after curettage with some adjutant treatments. Five patients in Grade Ⅰ (Campanicci’s radiological grading) hadno recurrence, 6 of the 11 patients in Grade Ⅱ had a recurrence, and 6 of the 11 patients in Grade Ⅲ had a recurrence. Two of the 9 patients in Grade Ⅰ (Enneking grading) had a recurrence, 6 of the 21 patients in Grade Ⅱ had a recurrence, and 4 of the patients in Grade Ⅲ had a recurrence; all the recurrent lesions were around the knee, with a duration of the recurrence ranging from 2 months to 36 months (average,14.3 months). Of the patients with the recurrence, 12 underwent reoperations (8 by the total resection of the recurrent tumor, 4 by the curettage with adjuvant treatments), and there was no recurrence after the reoperation. Conclusion Giant cell tumor of the bone usually recurs around the knee joint, especially at the proximal tibia, usually graded as Grade Ⅱ or Ⅲ bythe Campanicci’s radiological grading system. Simple curettage has a higher recurrence rate; therefore, extensive curettage and resection of the lesions combined with some adjuvant treatments after the correct diagnosis can beused to reduce the high recurrence rate of giant cell tumor of the bone.
In order to observe the curative effect and general reaction of locally used adriamycin (ADM)-loaded chitosan drug delivery system on giant cell tumor of bone after curettage. The cavities of 4 cases of giant cell tumor after curettage were filled with ADM-loaded chitosan drug delivery system with 4 times the dosage usually used for intravenous application. After operation, the concentration of ADM in plasma on the 1st, 2nd and 5th day, and the functions of liver and kidney on the 1st week, 1st month and 6th month were all investigated. The results were that the concentration of ADM in plasma was (143.05 +/- 27.55) ng/ml, (52.17 +/- 11.28) ng/ml and (4.25 +/- 3.07) ng/ml respectively, and the functions of liver and kidney were all normal in 6 months. After a follow-up of 7-19 months, no local or general reactions were observed and X-ray showed no recurrence. Therefore, it was concluded that the locally used ADM-loaded chitosan delivery system was safe and effective in treatment of giant cell tumor of bone after curettage.
From 1979, a total of 5 cases of giant cell tumor of the lower end of radius were treated by segmental resection, and vascularized fibular head transplantation, and reconstruction of the inferior radio-ulnar joint. The bone healed within 2-3 months. The patients were followed for 5-10 years. There was no recurrence, nor distant metastasis, and the functional recovery of extremities was satisfactory.The clinical materials, the operative techniques and the assessment of the long-term results were introduced.
ObjectiveTo evaluate the effect of bone cement filling on articular cartilage injury after curettage of giant cell tumor around the knee. MethodsFifty-three patients with giant cell tumor who accorded with the inclusion criteria were treated between January 2000 and December 2011, and the cl inical data were retrospectively analyzed. There were 30 males and 23 females, aged 16-69 years (mean, 34.2 years). The lesion located at the distal femur in 28 cases and at the proximal tibia in 25 cases. According to Campanacci grade, there were 6 patients at grade I, 38 at grade Ⅱ, and 9 at grade Ⅲ. Of 53 patients, 42 underwent curettage followed by bone cement fill ing, and 11 received curettage followed by bone grafts in the subchondral bony area and bone cement fill ing. Two groups were divided according to whether secondary osteoarthritis occurred or not during postoperative follow-up. The gender, age, lesion site, the subchondral residual bone thickness, tumor cross section, preoperative Campanacci grade, subchondral bone graft, and Enneking function score were compared between 2 groups, and multivariate logistic regression analysis was done. ResultsAll incisions healed by first intention. The average follow-up time was 65 months (range, 23-158 months). Of 53 cases, 37 (69.8%) had no osteoarthritis, and 16 (30.2%) had secondary osteoarthritis. Three cases (5.7%) recurred during the follow-up period. Univariate logistic regression analysis showed no significant difference in gender, age, lesion site, and Campanacci grade between 2 groups (P>0.1); difference was significant in the subchondral residual bone thickness, tumor cross section, Enneking function score, and subchondral bone graft (P<0.1). The multivariate logistic regression analysis showed that the decreased subchondral residual bone thickness, the increased tumor cross section, and no subchondral bone graft are the risk factors of postoperative secondary osteoarthritis (P<0.05). ConclusionCurettage of giant cell tumor around the knee followed by bone cement filling can increase the damage of cartilage, and subchondral bone graft can delay or reduce cartilage injury.
ObjectiveTo evaluate the long-term effectiveness of vascularized fibula flap in radiocarpal joint reconstruction following excision of Campanacci grade Ⅲ giant cell tumor (GCT) of distal radius.MethodsBetween December 2010 and December 2014, 10 patients with Campanacci grade Ⅲ GCT of distal radius were treated with en bloc excision and inradiocarpal joint reconstruction using vascularized fibula flap. They were 6 males and 4 females, with an average age of 39.9 years (range, 22-65 years). The disease duration was 1.5-6.0 months (mean, 2.6 months). The length of distal radius defect was 6.0-12.5 cm (mean, 8.4 cm) after en bloc excision of GCT. Vascularized fibula flap with inferior lateral genicular vessels were performed in 6 patients and with inferior lateral genicular vessels and peroneal vessels in 4 cases.ResultsAll incisions healed by first intention. All patients were followed up 4.4-8.3 years (mean, 6.0 years). There was no tumor recurrence during follow-up. At last follow-up, the mean ranges of motion of wrist joint were 55.0° (range, 25-85°) in extension, 26.5° (range, 15-40°) in flexion, 12.0° (range, 5-25°) in radial deviation, 19.6° (range, 10-30°) in ulnar deviation, 50.5° (range, 5-90°) in pronation, and 66.5° (range, 20-90°) in supination. The mean grip strength of effected wrist was 75% (range, 60%-85%) of the healthy wrist. The mean Musculoskeletal Tumor Society (MSTS) score was 82.7% (range, 75%-90%). X-ray films showed that the fibula flap healed at 12-16 weeks after operation (mean, 14.1 weeks) and there were 9 cases of radiological complications.ConclusionFor Campanacci grade Ⅲ GCT of distal radius, application of the vascularized fibula flap in radiocarpal joint reconstruction after en bloc excision of GCT can obtain good wrist function.