巨细胞瘤(GCT)是原发性骨肿瘤,最常见于长骨,一半的肿瘤发生在股骨远端,胫骨近端,和腓骨.大约12%的患者出现病理性骨折,表明疾病更具侵袭性。肿瘤切除术后关节固定术由于其经济实惠和术后早期动员是一种流行的选择,以及植入物松动的低风险,感染,恶性病变,或死亡率。游离腓骨移植物在长骨肿瘤的保肢手术中是一种流行的选择。骨移植物和钉可用于重建长达25厘米的长骨和桥缺损。在发展中国家,进口巨型假肢的成本,8500美元左右,意味着许多患者负担不起治疗费用。我们描述了一例股骨远端GCT的病例,该病例通过切除肿瘤并使用腓骨移植进行重建,膝关节固定术使用定制的长髓内互锁钉固定穿过股骨到膝盖和胫骨。该长度在手术后缩短1cm。结果令人满意,手术后三个月允许部分负重。在为期一年的随访中,没有复发,病人有完全的负重能力。
Giant cell tumors (GCTs) are primary bone tumors that occur most commonly in long bones, with half such tumors occurring in the distal femur, proximal tibia, and fibula. Around 12% of patients present with a pathological fracture indicating more aggressive disease. Arthrodesis after tumor resection is a popular choice due to its affordability and early postoperative mobilization, as well as low risks of implant loosening, infections, malignant lesions, or mortality. A free fibular graft is a popular option in limb-sparing surgery for long bone tumors. A bone graft and nail can be used to reconstruct long bones and bridge defects up to 25 cm. In developing countries, the cost of the imported mega prosthesis, around 8,500 US$, means many patients cannot afford the treatment. We describe a
case of a GCT of the distal femur treated by excision of the tumor and reconstruction using a fibular bone graft, with knee arthrodesis using a custom-made long intramedullary interlocking nail fixation across the femur to the knee and the tibia. The length was achieved with 1 cm shortening post-surgery. The result was satisfactory, and partial weight-bearing was allowed three months after the surgery. At the one-year follow-up, there was no recurrence, and the patient had the full weight-bearing ability.