三明治植骨技术重建股骨远端巨细胞瘤刮除骨缺损△（开放获取）

Sandwich bone grafting for bone defect secondary to giant cell tumor curettage in the distal femur

摘要:

[目的]介绍股骨远端骨巨细胞瘤的三明治植骨技术的手术技术和初步临床结果。[方法]2016 年 1 月—2024 年 12 月，25 例股骨远端骨巨细胞瘤患者接受此手术治疗。麻醉后保持患侧 30°仰卧位，沿股骨外侧肌间隙暴露至股骨骨皮质，电钻开窗，视野范围内尽量暴露整个病灶，依次使用刮匙彻底刮净瘤腔，电凝高温灼烧瘤壁，高速磨钻打磨瘤壁，保留关节软骨和部分关节下骨质。预先放置合适的股骨钢板并测量螺钉长度，用 1 枚螺钉将钢板固定并置于一侧。把骨修复材料均匀覆盖在关节软骨层侧，厚度 10~15 mm；然后覆盖明胶海绵，最后骨水泥填充瘤腔。回植灭活的骨窗骨片，摆正预留的钢板，骨水泥凝固前依次拧入螺钉固定，屈伸膝关节排除骨水泥溢入关节腔。[结果]所有患者手术均顺利完成。所有患者随访 6~84 个月。术后正位 X 线片示钢板远端与股骨关节面的距离为 0~56 mm，平均 （13.0±2.5) mm；植骨愈合时间 13~22 周，平均 （17.6±4.2） 周。MSTS 评分 21~30 分，平均（26.0±3.2）分。术后 4 例局部复发，1 例严重跛行，2 例局部有异物感，无感染、下肢深静脉血栓形成等。[结论]三明治植骨治疗股骨远端骨巨细胞瘤在技术上是可行的，具有立竿见影的稳定性，提高了关节保存成功率，取得了满意的初步临床效果。

Abstract:

[Objective] To introduce the surgical technique and its preliminary clinical outcomes of the sandwich bone grafting for bone defect secondary to curettage of the distal femoral giant cell tumor. [Methods] From January 2016 to December 2024, a total of 25 patients received this surgical treatment for bone giant cell tumor of the distal femur. After the patients were anesthetized, they were placed in a 30° supine position on the affected side. The surgical exposure was carried out along the lateral intermuscular space to the bone surface of the femur. A bone fenestration was made with an electric drill, and the entire lesion was exposed as much as possible within the visual field. The tumor was thoroughly removed with curettes in sequence. The tumor wall was cauterized at a high temperature by electrocoagulation, and then was polished with a high-speed burr with the articular cartilage and the outer subchondral bone preserved intact. A suitable femoral plate was pre-placed and fixed on one side with a screw, while the remaining screws measured in length. The artificial bone material was evenly placed on the the articular side in a layer with thickness of 10~15 mm, then, gelatin sponge was placed, and finally bone cement was poured into the remaining tumor cavity. The inactivated bone fragments harvested from fenestration were replanted, the preplaced plate was positioned correctly, and the screws were sequentially tightened for fixation before the bone cement solidified. The knee joint was flexed and extended to exclude the overflow of bone cement into the joint cavity. [Results] All patients had the surgical procedures performed successfully, and were followed up ranging from 6 to 84 months. The average distance between the distal end of the plate and the articular surface of the femur on the postoperative X-ray in the anteroposterior position was ranged from 0 mm to 56mm with a mean of (13.0± 2.5) mm, with the average healing time of bone graft ranged from 13 weeks to 22 weeks in a mean of (17.6±4.2) weeks. At the latest followup, the Musculoskeletal Tumor Society (MSTS) was of (26.0±3.2) (ranging from 21 to 30 points). Regarding adverse events, 4 cases were of local recurrence, 1 case of severe lameness, and 2 cases of local rejection after the operation, however, no infection, deep vein thrombosis of the lower limb and other complication were noted in anyone of them. [Conclusion] The sandwich bone grafting for the distal femoral bone giant cell tumor is technically feasible, provides immediate stability and increases the success rate of joint preservation, and achieves satisfactory preliminary clinical consequence.