| Objective: To compare the efficacy of resection and curettage for treatment of proximal humeral giant cell tumor;to explore influencing factors of surgical options of proximal humeral giant cell tumor;to explore risk factors of proximal recurrence of giant cell tumor of bone.Method: Patients' data were collected from six hospitals in Chinese giant cell tumor group(GTOC),including gender,age,pathological fracture,and soft tissue extension,time of diagnosis,image data,pathological report,complication,local recurrence and pulmonary metastasis.Data collection was performed using the medical electronic records,Follow-up records and telephone interview.From May 2002 to September 2014,48 patients with giant cell tumor of the proximal humerus were enrolled in this study,including 26 males and a 22 female with a mean age of 36 years(range,16-64 years).There were 23 patients(47.9%)with soft tissue extension,28 cases(58.3%)with pathological fracture,Campanacci Grade II GCT was diagnosed in 32 patients(66.7%);Campanacci Grade III GCT in 16 patients(33.3%).Surgical methods include curettage and resection.Functional results of upper limb were evaluated by Musculoskeletal Tumor Society(MSTS)Score,the data of range of shoulder motion were also recorded.Statistical analysis was done with SPSS software.Result: The mean follow-up time was 78.1 months(23-171 months).A total of 8 patients with recurrence,the total recurrence rate was 16.7%.3 cases of recurrence were found in the curettage group,with a recurrence rate of 20%,and 5 patients in the resection group,with a recurrence rate of 15.2%.Complications occurred in 8 patients,the total incidence of complications was 16.7%,7 cases in tumor resection group,with complications rate of 21.2%,1 in curettage group,and the rate of complications was 6.7%.The average MSTS score of 48 patients was 22.5 ± 4.8.The average score of curettage group was 28.8 ±0.9,and resection group was 19.6 ± 2.6,there was significant difference in MSTS score between curettage group and resection group(P<0.01).At time of last follow up,the average flexion angle of the shoulder was 69.6 degrees,the median of the posterior extension angle was 32.0 degrees,and the average abduction angle was 51.4 degrees.In resection group,the median flexion angle was 49.0 degrees,average abduction angle was 29.0 degrees,the average extension angle was 36.9 degrees;in curettage group,average flexion angle was 86.2 degrees,median abduction angle was 42.0 degrees and average extension angle 83.3 degrees,the difference between curettage group and resection group was statistically difference.The results of Logistic regression test showed that soft tissue involvement was the only factor affecting the selection of surgical method and the only risk factor for tumor recurrence.Conclusion: Compared with resection group,curettage group has lower complications rate,higher MSTS score and excellent shoulder function,although recurrence rate was higher than resection group.We suggest that,for Campanacci grade I and Campanacci grade II proximal humeral GCT,we recommend to use curettage as the first treatment.In this study,soft tissue extension was the only risk factor for the recurrence of proximal humeral giant cell tumor,means recurrence rate of GCT with soft tissue extension is higher,but considering the poor functional results after resection,soft tissue extension should not be consider as a contraindication for curettage.In our study,pathological fracture was not a risk factor for recurrence.Therefore,pathological fractures should not consider as a contraindications for curettage.The MSTS score,shoulder flexion degree,abduction degree and extension degree in resection group were lower than those in curettage group.Especially we measured obviously restricted range of abduction of shoulder after resection.Resection should be performed in patients with intra-articular fractures,subchondral bone destruction,comminuted fracture,large tumor with wide extension of soft tissue. |
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