目的:桡骨远端巨细胞瘤(GCT)的治疗仍然具有挑战性,对最佳手术管理没有共识。手术治疗仍然是治疗的主要方法,包括病灶内刮治和整块切除重建。本系统评价和荟萃分析的目的是评估和比较这两种方法的结果。
方法:使用OVID-Medline和Embase数据库,进行了系统的文献检索.比较研究,评估桡骨远端GCT患者的病灶内刮治和整块切除术,包括在内。有关局部复发率的数据,转移,整体并发症,和功能结果,进行了收集和分析。ROBINS-I工具用于评估每个研究结果中的偏倚风险。
结果:分析中纳入了13项研究(n=373例患者),报告了191例病灶内刮治手术和182例整块切除术。参与者的平均年龄为31.9(SD±2.4)岁,平均随访时间为7.1(SD±3.6)岁。进行病灶内刮治的患者更有可能发生局部复发(风险比(RR)3.3,95%CI,[2.1,5.4],与接受整块切除术的患者相比,p<0.00001)。在坎帕纳契3级病变中,局部复发的风险为5.9(95%CI,[2.2,16.3],p=0.0006)在接受病灶内刮治的患者中高出一倍。与整块切除术相比,进行病灶内刮治的患者出现整体并发症的相对风险降低了84%(95%CI,[0.1,0.4],p<0.00001),视觉模拟量下降幅度更大,手臂残疾降低,肩膀,和手(DASH)得分(p<0.00001)。发生局部复发的风险比,皮损内手术后PMMA与骨移植物无显著差异(RR1.2,95%CI,[0.6,2.6],p=0.62)。
结论:在桡骨远端GCT的外科治疗中,与整块切除重建相比,病灶内刮治增加了局部复发,特别是在3级肿瘤中。然而,手术并发症明显减少,较低的疼痛评分,与整块切除术相比,改善了功能结局。两种治疗方案在桡骨远端GCT的当代管理中仍然相关。在确定这些患者的最佳治疗策略时,手术决策应包括患者和肿瘤因素。3级证据:3级研究的荟萃分析。
OBJECTIVE: The treatment of giant cell tumors (GCT) of the distal radius remains challenging, with no consensus on the optimal surgical management. Surgical management remains the mainstay of treatment with options including intralesional curettage and en-bloc resection with reconstruction. The objective of this systematic
review and meta-analysis was to evaluate and compare the outcomes of these two procedures.
METHODS: Using OVID-Medline and Embase databases, a systematic literature search was performed. Comparative studies, assessing intralesional curettage and en-bloc resection in patients with GCTs of the distal radius, were included. Data regarding rates of local recurrence, metastasis, overall complications, and functional outcomes, were collected and analyzed. The ROBINS-I tool was utilized for risk of bias appraisal within each study outcome.
RESULTS: Thirteen studies (n = 373 patients) reporting on 191 intralesional curettage procedures and 182 en-bloc resections were included in the analysis. The average age of participants was 31.9 (SD ± 2.4) years and average follow-up was 7.1 (SD ± 3.6) years. Patients that underwent intralesional curettage were more likely to develop local recurrence (Risk Ratio (RR) 3.3, 95% CI, [2.1, 5.4], p < 0.00001) when compared to patients that underwent en-bloc resection. In Campanacci grade 3 lesions, the risk for local recurrence was 5.9 (95% CI, [2.2, 16.3], p = 0.0006) times higher in patients that received intralesional curettage. Patients that underwent intralesional curettage showed an 84% reduction in the relative risk of developing overall complications compared to en-bloc resection (95% CI, [0.1, 0.4], p < 0.00001), and a larger decrease in Visual Analog Scale and lower Disabilities of the Arm, Shoulder, and Hand (DASH) scores (p < 0.00001). Risk ratio for developing a local recurrence, with PMMA versus bone graft following an intralesional procedure was not significant (RR 1.2, 95% CI, [0.6, 2.6], p = 0.62).
CONCLUSIONS: In the surgical management of GCT of the distal radius, intralesional curettage increased local recurrence compared to en-bloc resection with reconstruction, particularly in grade 3 tumors. However, it led to significantly fewer operative complications, lower pain scores, and improved functional outcomes compared to en-bloc resection. Both treatment options remain relevant in the contemporary management of GCTs of the distal radius. Surgical decision making should include both patient and tumor factors when determining the optimal treatment strategy for these patients. LEVEL 3 EVIDENCE: Meta-analysis of Level 3 studies.