Abstract：
BACKGROUND: Giant cell tumors of bone (GCTBs) are rare, aggressive tumors, and the proximal humerus is a relatively rare location for GCTBs; limited evidence exists on which surgical approaches and reconstruction techniques are optimal. In the largest case series to date, we evaluated the recurrence rate of proximal humeral GCTBs and the functional outcomes of different resection and reconstruction options in this multicenter study.
METHODS: All 51 patients included in this study received initial surgical treatment for proximal humeral GCTBs from January 2007 to December 2020, with a minimum 2-year follow-up period. Local recurrence and functional outcomes were statistically analyzed in relation to demographic, clinical, and primary surgical variables. Functional outcomes were reported by patients and were assessed by the Musculoskeletal Tumor Society score and QuickDASH instrument (shortened version of the Disabilities of the Arm, Shoulder and Hand instrument).
RESULTS: The mean follow-up period was 81.5 months (range, 30-191 months), and the overall recurrence rate was 17.6% (9 of 51 patients). The majority of recurrences (n = 7) occurred in the first 2 years of follow-up. The intralesional curettage group (n = 23) showed a statistically significant difference in the recurrence rate compared with the en bloc resection group (n = 28) (34.8% vs. 3.6%, P = .007). Among shoulders receiving en bloc resection, 16 were reconstructed with hemiarthroplasty; 8, reverse total shoulder arthroplasty (rTSA) with allograft-prosthetic composite (APC) reconstruction; and 4, arthrodesis. On the basis of intention-to-treat analysis, the mean functional Musculoskeletal Tumor Society scores of the groups undergoing curettage, rTSA with APC, hemiarthroplasty, and arthrodesis were 26.0 ± 3.1, 26.0 ± 1.7, 20.3 ± 2.8, and 22.5 ± 1.3, respectively (P < .001 [with P < .001 for curettage vs. hemiarthroplasty and P = .004 for rTSA with APC vs. hemiarthroplasty]) and the mean QuickDASH scores were 14.0 ± 11.0, 11.6 ± 4.5, 33.1 ± 11.8, and 21.6 ± 4.7, respectively (P < .001 [with P < .001 for curettage vs. hemiarthroplasty and P = .003 for rTSA with APC vs. hemiarthroplasty]).
CONCLUSIONS: On the basis of our data, en bloc resection followed by reverse shoulder arthroplasty showed a lower recurrence rate and no significant difference in functional outcome scores for proximal humeral GCTBs compared with intralesional curettage. Therefore, we believe that rTSA with APC may be reasonable for the initial treatment of proximal humeral GCTBs.
METHODS: All 51 patients included in this study received initial surgical treatment for proximal humeral GCTBs from January 2007 to December 2020, with a minimum 2-year follow-up period. Local recurrence and functional outcomes were statistically analyzed in relation to demographic, clinical, and primary surgical variables. Functional outcomes were reported by patients and were assessed by the Musculoskeletal Tumor Society score and QuickDASH instrument (shortened version of the Disabilities of the Arm, Shoulder and Hand instrument).
RESULTS: The mean follow-up period was 81.5 months (range, 30-191 months), and the overall recurrence rate was 17.6% (9 of 51 patients). The majority of recurrences (n = 7) occurred in the first 2 years of follow-up. The intralesional curettage group (n = 23) showed a statistically significant difference in the recurrence rate compared with the en bloc resection group (n = 28) (34.8% vs. 3.6%, P = .007). Among shoulders receiving en bloc resection, 16 were reconstructed with hemiarthroplasty; 8, reverse total shoulder arthroplasty (rTSA) with allograft-prosthetic composite (APC) reconstruction; and 4, arthrodesis. On the basis of intention-to-treat analysis, the mean functional Musculoskeletal Tumor Society scores of the groups undergoing curettage, rTSA with APC, hemiarthroplasty, and arthrodesis were 26.0 ± 3.1, 26.0 ± 1.7, 20.3 ± 2.8, and 22.5 ± 1.3, respectively (P < .001 [with P < .001 for curettage vs. hemiarthroplasty and P = .004 for rTSA with APC vs. hemiarthroplasty]) and the mean QuickDASH scores were 14.0 ± 11.0, 11.6 ± 4.5, 33.1 ± 11.8, and 21.6 ± 4.7, respectively (P < .001 [with P < .001 for curettage vs. hemiarthroplasty and P = .003 for rTSA with APC vs. hemiarthroplasty]).
CONCLUSIONS: On the basis of our data, en bloc resection followed by reverse shoulder arthroplasty showed a lower recurrence rate and no significant difference in functional outcome scores for proximal humeral GCTBs compared with intralesional curettage. Therefore, we believe that rTSA with APC may be reasonable for the initial treatment of proximal humeral GCTBs.
摘要：
背景：骨巨细胞瘤（GCTB）是罕见的侵袭性肿瘤，肱骨近端也是GCTB相对罕见的部位，关于哪些手术入路和重建技术是最佳的证据有限.这里,使用迄今为止最大的案例系列，在这项多中心研究中,我们评估了肱骨近端GCTB的复发率以及不同切除和重建方案的功能结局.
方法：从2007年1月至2020年12月，所有51例患者接受了肱骨近端GCTB的初始手术治疗，至少随访两年。对局部复发和功能结局进行了统计学分析，临床,和主要手术变量。功能结果由患者报告，并通过肌肉骨骼肿瘤协会（MSTS）评分和手臂残疾进行评估。肩和手（QuickDASH）仪器。
结果：平均随访时间为81.5个月（范围，30-191个月），总复发率为17.6%(9/51)。大多数复发（N=7）发生在随访的前两年。病灶内刮宫组（N=23）与整块切除术（N=28）相比，复发率差异具有统计学意义（34.8％vs.3.6%,p=0.007)。在接受整块切除术的患者中，用半髋关节置换术重建了16个肩膀，8采用反向全肩关节置换术（rTSA）与同种异体移植-假体复合材料（APC）重建，和4关节固定术。基于意向治疗分析，刮宫组的平均功能MSTS评分，rTSA与APC，半髋关节置换术,或关节固定术为26.0±3.1vs.26.0±1.7vs.20.3±2.8vs.22.5±1.3（p<0.001[刮宫术与半髋关节置换术,p<0.001；rTSA与APC对比半髋关节置换术,p=0.004]),分别,而对于QuickDASH，它是14.0±11.0vs.11.6±4.5vs.33.1±11.8vs.21.6±4.7（p<0.001[刮治与半髋关节置换术,p<0.001；rTSA与APC对比半髋关节置换术,p=0.003]),分别。
结论：根据我们的数据，整块切除后再进行反向肩关节置换术显示复发率较低，与病灶内刮治相比，肱骨近端GCTB的功能结局评分无显着差异。因此,我们认为rTSA联合APC对于肱骨近端GCTBs的初始治疗可能是合理的.
方法：从2007年1月至2020年12月，所有51例患者接受了肱骨近端GCTB的初始手术治疗，至少随访两年。对局部复发和功能结局进行了统计学分析，临床,和主要手术变量。功能结果由患者报告，并通过肌肉骨骼肿瘤协会（MSTS）评分和手臂残疾进行评估。肩和手（QuickDASH）仪器。
结果：平均随访时间为81.5个月（范围，30-191个月），总复发率为17.6%(9/51)。大多数复发（N=7）发生在随访的前两年。病灶内刮宫组（N=23）与整块切除术（N=28）相比，复发率差异具有统计学意义（34.8％vs.3.6%,p=0.007)。在接受整块切除术的患者中，用半髋关节置换术重建了16个肩膀，8采用反向全肩关节置换术（rTSA）与同种异体移植-假体复合材料（APC）重建，和4关节固定术。基于意向治疗分析，刮宫组的平均功能MSTS评分，rTSA与APC，半髋关节置换术,或关节固定术为26.0±3.1vs.26.0±1.7vs.20.3±2.8vs.22.5±1.3（p<0.001[刮宫术与半髋关节置换术,p<0.001；rTSA与APC对比半髋关节置换术,p=0.004]),分别,而对于QuickDASH，它是14.0±11.0vs.11.6±4.5vs.33.1±11.8vs.21.6±4.7（p<0.001[刮治与半髋关节置换术,p<0.001；rTSA与APC对比半髋关节置换术,p=0.003]),分别。
结论：根据我们的数据，整块切除后再进行反向肩关节置换术显示复发率较低，与病灶内刮治相比，肱骨近端GCTB的功能结局评分无显着差异。因此,我们认为rTSA联合APC对于肱骨近端GCTBs的初始治疗可能是合理的.
