国际肿瘤学杂志

国际肿瘤学杂志 ›› 2020, Vol. 47 ›› Issue (7): 409-413.doi: 10.3760/cma.j.cn371439-20200527-00046

• 论著 • 上一篇    下一篇

局部及全身应用唑来膦酸治疗骨巨细胞瘤的临床效果

苏文珍, 林永杰(), 王正宇, 刘吉松   

  1. 山东省立第三医院关节与运动医学外科,济南 250031
  • 收稿日期:2020-05-27 修回日期:2020-06-15 出版日期:2020-07-08 发布日期:2020-08-18
  • 通讯作者: 林永杰 E-mail:linyongjie123@163.com

Clinical effect of local and systemic zoledronic acid in the treatment of giant cell tumor of bone

Su Wenzhen, Lin Yongjie(), Wang Zhengyu, Liu Jisong   

  1. Department of Joint and Sports Medicine Surgery, Shandong Provincial Third Hospital, Shandong University, Jinan 250031, China
  • Received:2020-05-27 Revised:2020-06-15 Online:2020-07-08 Published:2020-08-18
  • Contact: Lin Yongjie E-mail:linyongjie123@163.com

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摘要：

目的 探讨局部及全身应用唑来膦酸治疗骨巨细胞瘤的临床效果。方法 回顾性分析2000年1月至2017年1月在山东省立第三医院关节与运动医学外科就诊的骨巨细胞瘤患者42例的临床资料,根据术中及术后是否应用唑来膦酸分为唑来膦酸组(n=21)和非唑来膦酸组(n=21),比较两组患者围手术期手术相关指标、疼痛视觉模拟评分(VAS)、下肢功能国际骨与软组织肿瘤协会(MSTS)评分、不良反应及术后复发情况。结果 唑来膦酸组和非唑来膦酸组患者的手术时间分别为(158.4±20.5)min、(169.5±19.5)min,术中出血量分别为(236.3±9.7)ml、(228.2±16.5)ml,术后引流量分别为(163.3±7.4)ml、(161.4±9.3)ml,切口愈合时间分别为(13.8±2.1)d、(14.0±2.0)d,差异均无统计学意义(t=-1.798,P=0.080;t=1.936,P=0.062;t=0.733,P=0.468;t=-0.290,P=0.774)。两组患者术前VAS评分分别为6.54±1.76、6.72±1.51,MSTS评分分别为13.56±2.35、12.79±1.98,差异均无统计学意义(t=-0.356,P=0.724;t=1.148,P=0.258)。两组患者术后4周的VAS评分分别为1.32±0.31、1.92±0.19,术后3个月的VAS评分分别为0.93±0.29、1.47±0.38,差异均具有统计学意义(t=-7.562,P<0.001;t=-5.177,P<0.001);末次随访VAS评分分别为0.31±0.12、0.35±0.23,差异无统计学意义(t=0.707,P=0.485)。两组患者术后4周的MSTS评分分别为24.89±3.86、21.82±2.95,术后3个月的MSTS评分分别为26.78±2.57、24.62±2.62,差异均具有统计学意义(t=2.896,P=0.006;t=2.697,P=0.010);末次随访MSTS评分分别为27.31±2.21、26.69±2.93,差异无统计学意义(t=0.774,P=0.443)。两组患者术后复发时间分别为(9.79±2.58)个月、(7.31±1.73)个月,差异有统计学意义(t=3.659,P=0.001)。两组患者复发Campanacci分级及复发瘤体位置差异均无统计学意义(U=7.000,P=0.860;χ2=1.062,P>0.999)。两组患者发热发生率分别为23.81%(5/21)、4.76%(1/21),肌痛发生率分别为19.05%(4/21)、4.76%(1/21),流感样症状发生率分别为14.29%(3/21)、0(0/21),胃肠道反应发生率分别为9.52%(2/21)、4.76%(1/21),差异均无统计学意义(χ2=1.750,P=0.186;χ2=0.980,P=0.341;χ2=1.436,P=0.231;χ2<0.001,P>0.999),所有患者均未出现肝肾功能损害、下颌骨坏死等严重不良反应。结论 局部及全身应用唑来膦酸治疗骨巨细胞瘤可改善患者术后早期疼痛及患肢功能,延缓复发时间,可作为骨巨细胞瘤的辅助治疗方案。

关键词: 骨巨细胞瘤, 二磷酸盐类, 治疗应用

Abstract:

Objective To investigate the clinical effect of local and systemic zoledronic acid in the treatment of giant cell tumor of bone. Methods The clinical data of 42 patients with giant cell tumor of bone who were treated in the Department of Joint and Sports Medicine Surgery of Shandong Provincial Third Hospital from January 2000 to January 2017 were retrospectively analyzed. According to whether zoledronic acid was used during and after operation, the patients were divided into zoledronic acid group (n=21) and non zoledronic acid group (n=21). The perioperative indexes, pain visual analogue scale (VAS), international Musculoskeletal Tumor Society (MSTS) score of lower extremity function, adverse reactions and the postoperative recurrence were compared between the two groups. Results The operative time of zoledronic acid group and non zoledronic acid group were (158.4±20.5) min and (169.5±19.5) min, the intraoperative bleeding volume were (236.3±9.7) ml and (228.2±16.5) ml, the postoperative drainage volume were (163.3±7.4) ml and (161.4±9.3) ml, and the healing time of incision were (13.8±2.1) d and (14.0±2.0) d, respectively, with no significant difference (t=-1.798, P=0.080; t=1.936, P=0.062; t=0.733, P=0.468; t=-0.290, P=0.774). The preoperative VAS scores of zoledronic acid group and non zoledronic acid group were 6.54±1.76 and 6.72±1.51 respectively, the MSTS scores were 13.56±2.35 and 12.79±1.98 respectively, and the differences were not statistically significant (t=-0.356, P=0.724; t=1.148, P=0.258). The VAS scores of the two groups were 1.32±0.31 and 1.92±0.19 at 4 weeks after operation, 0.93±0.29 and 1.47±0.38 at 3 months after operation respectively, and the differences were statistically significant (t=-7.562, P<0.001; t=-5.177, P<0.001). The VAS scores of the two groups were 0.31±0.12 and 0.35±0.23 at the last follow-up, with no significant difference (t=0.707, P=0.485). The MSTS scores of zoledronic acid group and non zoledronic acid group were 24.89±3.86 and 21.82±2.95 at 4 weeks after operation, 26.78±2.57 and 24.62±2.62 at 3 months after operation respectively, and the differences were statistically significant (t=2.896, P=0.006; t=2.697, P=0.010). The MSTS scores of the two groups were 27.31±2.21 and 26.69±2.93 at the last follow-up, with no significant difference (t=0.774, P=0.443). The postoperative recurrence time of the two groups was (9.79±2.58) months and (7.31±1.73) months respectively, and the difference was statistically significant (t=3.659, P=0.001). There was no significant difference in recurrence Campanacci grade and recurrence tumor location between the two groups (U=7.000, P=0.860; χ2=1.062, P>0.999). The occurrence rates of fever in zoledronic acid group and non zoledronic acid group were 23.81% (5/21) and 4.76% (1/21), the occurrence rates of myalgia were 19.05% (4/21) and 4.76% (1/21), the incidences of influenza like symptoms were 14.29% (3/21) and 0 (0/21), the occurrence rates of gastrointestinal reaction were 9.52% (2/21) and 4.76 (1/21), and the differences were not statistically significant (χ2=1.750, P=0.186; χ2=0.980, P=0.341; χ2=1.436, P=0.231; χ2<0.001, P>0.999). All the patients had no serious adverse reactions such as liver and kidney function damage and mandible necrosis. Conclusion Local and systemic application of zoledronic acid in the treatment of giant cell tumor of bone can improve the early postoperative pain and limb function, delay the recurrence time, and can be used as an auxiliary treatment of giant cell tumor of bone.

Key words: Giant cell tumor of bone, Diphosphates, Therapeutic uses