Purpose: To find out the most appropriate management scheme through the analysis and comparison of different inactivation methods and filling materials.Method: A systematic literature search was performed using the terms, anhydrous ethanol, phenol, hypertonic saline, cryotherapy, thermal therapy, bone reconstruction, GCTB, and etc., Selected articles were studied and summarized. The mechanism, clinical effects, and influence on bone repair of various methods are presented. Recent developments and perspectives are also demonstrated.Recent Findings: Compared to curettage alone, management of the residual cavity can effectively reduce the recurrence of giant cell tumours of bone. It is a complex and multidisciplinary process that includes three steps: local control, cavity filling, and osteogenic induction. In terms of local control, High-speed burring can enlarge the area of curettage but may cause the spread and planting of tumour tissues. Among the inactivation methods, Anhydrous ethanol, and hyperthermia therapy are relatively safe and efficient. The combination of the two may achieve a better inactivation effect. When inactivating the cavity, we need to adjust the approach according to the invasion of the tumour. Filling materials and bone repair should also be considered in management.
Background In recent years, researchers have proposed a number of adjuvant methods for extended curettage of giant cell tumors of the bone. However, various schemes have significant differences in efficacy and safety. Therefore, this article will describe an empirical expanded curettage protocol, ‘triple clear’, in detail to show the effect of the efficient surgical protocol. Method Patients with Campanacci grades II and III primary GCTB who were treated with either SR (n = 39) or TC (n = 41) were included. Various perioperative clinical indicators, including the therapy modality, operation time, Campanacci grade, and filling material were recorded and compared. The pain level was determined by the visual analog scale. Limb function was determined by the Musculoskeletal Tumour Society (MSTS) score. Follow-up time, recurrence rates, reoperation rates, and complication rates were also recorded and compared. Result The operation time was 135.7 ± 38.4 min in the TC group and 174.2 ± 43.0 min in the SR group (P < 0.05). The recurrence rates were 7.3% in the TC group and 8.3% in the SR group (P = 0.37). The MSTS scores at three months after surgery were 19.8 ± 1.5 in the TC group and 18.8 ± 1.3 in the SR group. The MSTS scores at two years were 26.2 ± 1.2 in the TC group and 24.3 ± 1.4 in the SR group (P < 0.05). Conclusion TC is recommended for patients with Campanacci grade II–III GCTB and for those with a pathological fracture or slight joint invasion. Bone grafts may be more suitable than bone cement in the long term.
Objectives: 1) To describe a systematic process for giant cell tumours of bone (GCTB). 2) To compare the clinical effects of ‘triple clear’ (TC) and segmental resection (SR), bone grafts and bone cement.Method: Patients with primary GCTB graded Companacci II and III who were treated with either SR (n = 39) or TC (n = 41) were included. The pain level was determined by the Visual Analogue Scale. Limb function was determined by the Musculoskeletal Tumour Society (MSTS) score.Result: The operating time was 135.7±38.4 min in the TC group and 174.2±43.0 min in the SR group (P<0.05). The recurrence rates were 7.3% and 10.0%, respectively (P = 0.37). The MSTS scores at three months after surgery were 19.8±1.5 in the TC group and 18.8±1.5 in the SR group. The MSTS scores at two years were 26.3±0.7 and 24.2±1.6, respectively (P<0.05).Conclusion: TC is recommended for GCTB graded Companacci II-III and GCTB accompanied by pathological fracture or joint invasion. Bone grafts may be more suitable than bone cement in the long term.
Objective: Total en bloc spondylectomy (TES) is an important surgical treatment for spinal tumors that can achieve en bloc resection of the affected vertebral body by using the T-saw. However, the conventional TES process and the surgical instruments currently in use have some inconveniences, which may lead to longer operative times and a higher incidence of complications. To address these obstacles, we developed a modified TES technique using a homemade intervertebral hook blade. The objectives of this study were to describe our modified total en bloc spondylectomy (TES) using a homemade intervertebral hook blade and to assess its clinical effects in patients with spinal tumors. Methods: Twenty-three consecutive patients with spinal tumors were included from September 2018 to November 2021. Eleven patients underwent a modified TES using an intervertebral hook blade, and 12 patients underwent a conventional TES using a wire saw. Details of the modified technique for TES were depicted, and the intraoperative blood loss, operative time, and improvement in pain symptom and neurological function measured by visual analog score (VAS) and American Spinal Injury Association (ASIA) score of all patients was reviewed and analyzed. Nonparametric analysis of covariates (ANCOVA) was performed to compare the clinical outcomes between patients treated with modified TES and conventional TES. Results:The modified TES significantly reduced operative time (F = 7.935, p = 0.010) and achieved favorable improvement of neurological function (F = 0.570, p = 0.459) and relief of pain (F = 3.196, p = 0.088) compared with the conventional TES group. The mean intraoperative blood loss in the modified TES group (2381.82 ml) was lower than that in the conventional TES group (3558.33 ml), although the difference was not statistically significant (F = 0.677, p = 0.420).Conclusions: Modified TES using the intervertebral hook blade can effectively reduce the operation time and intraoperative bleeding, and meanwhile ensure the improvement of neurological function and relief of pain symptoms, suggesting that this modified technique is feasible, safe, and effective for spinal tumors.
Background: 1) To describe a systematic process for giant cell tumours of bone (GCTB). 2) To compare the clinical effects of ‘triple clear’ (TC) and segmental resection (SR), bone grafts and bone cement.Method: Patients with Campanacci grades II and III primary GCTB who were treated with either SR (n = 39) or TC (n = 41) were included. The pain level was determined by the Visual Analogue Scale. Limb function was determined by the Musculoskeletal Tumour Society (MSTS) score.Result: The operation time was 135.7±38.4 min in the TC group and 174.2±43.0 min in the SR group (P<0.05). The recurrence rates were 7.3% in the TC group and 10.0% in the SR group (P = 0.37). The MSTS scores at three months after surgery were 19.8±1.5 in the TC group and 18.8 ±1.5 in the SR group. The MSTS scores at two years were 26.3±0.7 in the TC group and 24.2±1.6 in the SR group (P<0.05). Conclusion: TC is recommended for patients with Campanacci grade II-III GCTB and for those with GCTB accompanied by pathological fracture or joint invasion. Bone grafts may be more suitable than bone cement in the long term.
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