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目的探讨髌骨骨巨细胞瘤的外科治疗效果。方法回顾性分析2004年2月～2009年5月收入我院的1例和外院会诊的3例髌骨骨巨细胞瘤患者的临床资料。其中男性和女性各2例;年龄20～37岁,平均26.8岁;左膝3例,右膝1例。所有患者均以前膝痛为首发症状,X线片显示髌骨溶骨性病变,骨皮质膨胀,边缘硬化。CampanacciⅠ级1例和Ⅱ级2例行病变刮除植骨术,Ⅲ级1例行髌骨全切术。术后病理均确诊为骨巨细胞瘤。结果 3例刮除植骨的患者分别随访24、31和62个月,所有患者症状消失,局部无复发,无肺转移,膝关节活动正常,随访X线片显示不同程度的骨融合。髌骨切除的患者通过加强膝关节屈伸和股四头肌功能锻炼,术后13个月除行走稍跛行外,膝关节活动正常。结论对于前膝痛的年轻患者,应警惕髌骨肿瘤的可能性。髌骨骨巨细胞瘤CampanacciⅠ级和Ⅱ级的病变可采用刮除植骨术,Ⅲ级选择髌骨全切术。临床疗效满意。
Objective To investigate the surgical treatment of patellar giant cell tumor. Methods The clinical data of 1 patient with patellofemoral giant cell tumor who were admitted to our hospital from February 2004 to May 2009 were retrospectively analyzed. Including 2 males and 2 females; aged 20 to 37 years, mean 26.8 years old; 3 cases of left knee and 1 case of right knee. All patients had prior knee pain as the first symptom, X-ray showed patella osteolytic lesions, cortical expansion, marginal sclerosis. 1 cases of Campanacci grade Ⅰ and Ⅱ grade 2 lesions curettage and bone graft surgery, grade Ⅲ 1 cases of patellar total resection. Postoperative pathology were diagnosed as giant cell tumor of bone. Results Three patients who underwent bone scraping and grafting were followed up for 24, 31 and 62 months respectively. All patients had no symptoms, no recurrence, no lung metastasis and normal knee joint activity. X - ray showed different degrees of bone fusion. Patients who underwent patellar resection achieved normal knee function by strengthening knee flexion and quadriceps function exercises at 13 months after surgery, except for a slight limping. Conclusions For young patients with pre-knee pain, the possibility of patellar tumors should be warned. Patellar giant cell tumor Campanacci grade and grade Ⅱ lesions can be used to curettage and bone grafting, Ⅲ level patellar resection. Satisfactory clinical efficacy.