| 病灶内切除与整块切除治疗桡骨远端骨巨细胞瘤的Meta分析 |
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Received:February 20, 2015
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| 作者 | Author | 单位 | Unit | E-Mail |
| 尹振春 |
YIN Zhen-chun |
宁波市第二医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China |
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| 刘丙根 |
LIU Bing-gen |
宁波大学医学院, 浙江 宁波 315211 |
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| 庞清江 |
PANG Qing-jiang |
宁波市第二医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China |
庞清江E-mailPqjey@sina.com |
| 陈先军 |
CHEN Xian-jun |
宁波市第二医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China |
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| 余霄 |
YU Xiao |
宁波市第二医院骨科, 浙江 宁波 315010 |
Department of Orthopaedics, Ningbo No.2 Hospital, Ningbo 315010, Zhejiang, China |
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| 期刊信息：《中国骨伤》2016年29卷，第1期，第58-64页 |
| DOI：10.3969/j.issn.1003-0034.2016.01.013 |
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目的:用Meta分析的方法对国内外已发表较高质量的有关比较病灶内切除术和整块切除术对桡骨远端骨巨细胞瘤患者术后复发率、并发症发生率和功能康复结果的临床研究进行综合定量分析,为桡骨远端骨巨细胞瘤的外科治疗模式的选择提供参考依据。
方法:计算机检索Cochrane图书馆(2014年8期)、PubMed、Ovid、Elsevier、CNKI等数据库。检索从(1970-01-01/2013-01-01)年有关病灶内切除与整块切除治疗治疗桡骨远端骨巨细胞瘤的文献,筛选出符合纳入标准的文献,并对其进行严格的质量评价。利用Cochrane 协作网提供的RevMan 5.0软件对纳入研究结果进行Meta分析,并对数据进行异质性检验。计算病灶内切除术相对整块切除术其复发及并发症发生危险的优势比(OR),评价病灶内切除术与整块切除术对桡骨远端骨巨细胞瘤患者复发及并发症发生的影响。
结果:符合纳入标准的文献7篇,总样本量163例。其中病灶内切除术组92例(PMMA n=54,骨移植 n=33,非PMMA 或非骨移植 n=5),整块切除术组71例。病灶内切除术组骨巨细胞瘤复发率比整块切除术组高[OR=3.87,95%CI(1.42,10.53)],而在Campanacci 3级GCTs中[OR=10.12,95%CI(1.57,65.27)],病灶内切除术组并发症发生率更少[OR=0.13,95%CI(0.04,0.40)],病灶内切除术组内用PMMA与骨移植物充填病灶的复发率没有明显差异[OR=0.96,95%CI(0.26,3.56)].通过选择用MSTS系统评价、VAS系统评价和握力计系统评价时,病灶内切除术组在功能康复结果中优于整块切除组。
结论:基于有限的资料,表明整块切除术更加适合治疗桡骨远端骨巨细胞瘤,而病灶内切除术在治疗桡骨远端骨巨细胞瘤的Campanacci 1、2级比3级更加适合,病灶内切除桡骨远端骨巨细胞瘤方面,PMMA并不优于骨移植物。病灶内切除桡骨远端骨巨细胞瘤在功能康复方面优于整块切除组。 |
| [关键词]:桡骨 骨巨细胞瘤 外科治疗 Meta 分析 |
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| Intralesional curettage and wide excision for treatment of giant cell tumors (GCTs) of the distal radius:A Meta-analysis |
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Abstract:
Objective:To search all studies that had been published in the world with regarding to the effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complications and comparative functional outcomes in patients with giant cell tumours(GCT) of the distal radius and analyze them which were in high quality by means of Meta analysis,in order to give some evidences for the choice of method dealing with giant cell tumors GCT in surgery.
Methods: Cochrane central register of controlled trials(Issue 8 2014),PubMed(1970-01-01/2013-01-01),Ovid (1970-01-01/2013-01-01),Elsevier (1970-01-01/2013-01-01),CNKI (1970-01-01/2013-01-01) were searched. Including intralesional curettage and wide excision were performed to treat giant cell tumors (GCTs) of the distal radius in the literatures,selecting on meet eligibility in the standard literatures underwent strict quality assessment. The Meta-analysis was performed with software RevMan5.0 from the Cochrane collaboration. Additionally,the analysis checked the heterogeneity of data. The effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complication in patients with giant cell tumours of the distal radius were evaluated and Odds Ratio was calculated.
Results:Seven relevant articles were identified involving total 163 cases. Among them,92 cases were intralesional curettage (PMMA,n=54;bone graft,n=33;no PMMA or bone grafts,n=5) and 71 cases were wide excision. The patients in the intralesional curettage group had a higher recurrence rate [OR=3.87,95%CI(1.42,10.53)],especially for Campanacci grade 3 GCTs [OR=10.12,95%CI(1.57,65.27)],yet fewer major complications [OR=0.13,95%CI(0.04,0.40)] than the wide excision group. The use of PMMA versus bone graft did not affect the recurrence rate [OR=0.96,95%CI(0.26,3.56)]. By selecting the system evaluation of MSTS,the VAS and dynamometer,the result showed that the intralesional curettage group was equivalent or preferable to wide excision in terms of function rehabilitation.
Conclusion:Based on data obtained from the limited number of studies available,intralesional curettage appears to be more appropriate for the treatment of local lesions (Grade 1 and 2) than Grade 3 GCTs of the distal radius. Moreover,PMMA was not additionally effective as an adjuvant,the intralesional curettage group was found to be equivalent or preferable to wide excision in terms of function rehabilitation. |
| KEYWORDS:Radius Giant cell tumors Surgical therapy Meta-analysis |
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| 引用本文，请按以下格式著录参考文献： |
| 中文格式: | 尹振春,刘丙根,庞清江,陈先军,余霄.病灶内切除与整块切除治疗桡骨远端骨巨细胞瘤的Meta分析[J].中国骨伤,2016,29(1):58~64 |
| 英文格式: | YIN Zhen-chun,LIU Bing-gen,PANG Qing-jiang,CHEN Xian-jun,YU Xiao.Intralesional curettage and wide excision for treatment of giant cell tumors (GCTs) of the distal radius:A Meta-analysis[J].zhongguo gu shang / China J Orthop Trauma ,2016,29(1):58~64 |
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