The Surgical Therapy Of The Chondroblastoma

Background Chondroblastoma of bone is a rare lesion,and few large series have been reported. Object The purpose of this paper is to report thirty-two cases treated by one group of orthopaedic oncologic surgeans and to discuss the origin, the nature, the clinical manifestation, the diagnosis, the therapy and the curative effect of the chondroblastoma of bone.Methods Forty-four patients with chondroblastoma of bone were treated between 1989 January and 2002 December. We were able to obtain historical data, imaging studies, histological findings, and adequate personal or telephone follow-up to determine the outcome for thirty-two. We analyzed the data retrospectively and referrd to corresponding literature.Result There were twenty-one males and eleven females in this group, with meso age 19 (from thirteen to thirty). The lesions were distributed widely in the skeleton, but most were in the epiphyses or apophyses of the long bones,especially the proximal part of the tibia (eight tumors), the proximal part of the humerus (seven tumors) and the distal part of the femur (six tumors). Four tumors were located in the proximal part of the femur; two in ilium. One each was located in the fibula, the patella, the calcaneus, the proximal part of the ulna, the proximal part of the radius. The principal presenting symptoms were pain, limitation of movement, the swelling of soft tissue and the evident tenderness. The duration was several months to several years. The radiographic features of this neoplasm were highly characteristic and consist of an osteolytic lesion eccentrically or centrally located in an epiphysis or apophysis, usually less than 3 or 6 cm in size, and well defined and spheroid or oval in shape. A thin sclerotic rim may separate the tumor from adjacent normal bone. Calcific foci within the lesion were appeared in twelve cases (37.5%). The majority of the patients had intralesional curettage and the cavity of tumor were inactivated by the liquid nitrogen or the hydrogen peroxide or the zinc chloride or the electrical surgery unit, then packed with allograft or autograft bone chips or polymethylmethacrylate or artificial bone. The follow up of all patients were from eleven months to thirteen years, averaged seventy-eight months. A patient with the tumor in the proximal part of the femur had had intralesional curettage and packing with autograft bone chips twenty-two years ago and had a local recurrence fourteen years ago then had intralesional curettage and packing with autograft bone chips again had no recurrence till the end of the follow up. Another patient with the chondroblastoma in the proximal parrt of the proximal femur had had intralesional curettage and packing with allograft bone chips and three years later it seemed that the focus had enlarged so the patient had intralesional curettage and packing with iliac crest autograft again. It was found that the allograft bone didn't unite with the host bone and there was no historical findings of chondroblastoma and the tumor didn't recur till the end of follow up. The other patients had no local recurrenc or metastasis of the chondroblastoma. The rate of local recurrenc of our group was 6.3%. Most of the patients had an excellent functional result except for one patient who felt slight pain in daily activities but the range of motion of the knee didn't reduced and could complete almost all daily activities independently.Conclusions The chondroblastoma of bone was an uncommon, benign, cartilaginous neoplasm originating in bone, the effect of operation was good.