The Short To Medium Term Observation Of Effect Of Reconst-ructing Knee Function By Autogenous Bone Graft And Unico-mpartmental Knee Arthroplasty After Tibia Giant Cell Tumor Resection

Objective：Giant Cell Tumor(GCT) is a primary intramedullary tumorwith potentially malignant, the most commonly affected bones are the distalfemur and proximal tibia, which has large effect on the knee joint functionwith a high morbidity in patients. Accompanied with the progress of treatmentresearch of GCT, the recurrence and morbidity has been reduced. The maintreatment of GCT is surgical resection which concludes resection within thetumor and bloc tumor excision with rebuilt the knee function. To smallertumor, after scratch using burning with electrotome, grinding with high speeddrill or corrosive chemicals have achieved good results, when there is bonedefect,bone graft or bone cement filling should be taken into use. When theinvasion is larger than two-thirds of the tibial condyles diameter, artificialjoint or allograft joint transplantation could be better way to reconstruct kneejoint function. But when comes across the tumor invades the tibial condyleand articular cartilage, after radical resection, appeared large defects tibialcondyle joint, this may lead to high morbidity. Therefore we urgently needone way to solve this problem after radical resection of tumor in the knee, andin the same time reserve the function of the knee joint as more as possible.Inour research, through excising GCT in the tibial condyle, with autogenousiliac graft, internal fixation by screw or locking metal plate, single condylearthroplasty, rebuilt the knee joint function. After clinical following-up byEnneking lower limb function evaluation system and unicompartmental kneereplacement criteria evaluation system, evaluate postoperative effect, then weput forward the operation steps and treatment of tibial single condyle tumor.Methods：Retrospective analysis of six cases of proximal tibial condyle with giant cell tumor from July2008to June2012,in which4males and2females,3cases in lateral condyle and3cases in internal condyle,4cases ofⅡ period and2cases of Ⅲ period by X-ray manifestation in Campanaccicriteria, age range from21to44years old and average36.1with the first onsetand history of3~9months. According to CT cross-section, tumor destructionless than half of maximum lateral axis, articular cartilage surface significantlyinvaded,1cases with soft tissue invasion,2cases with pathologic fracture.Determine the size of the tumor excision, autogenous iliac and which kind ofinternal fixation materials by preoperative imaging data, then throughborderline tumor resection, autogenous iliac graft, internal fixation andsuitable artificial tibial condyle arthroplasty to reconstruct the joint function.After exercise, follow-up in postoperative, evaluate preoperative andpostoperative knee function in statistical analysis by Enneking lower limbfunction evaluation system and unicompartmental knee replacement criteriaevaluation system.Result：Followed the successful operation, going on7months-5yearscli-nical follow-up（average29.5months）,the graft bone healed well, no jointcollapse and prosthesis loosening, without recurrence,the knee joint functionrecovered well, the curative effect was satisfied according to the functionalevaluation put forward by International Society of Limb Salvage (ISOLS) andunicompartmental knee replacement criteria evaluation system.Application ofInternational Society of Limb Salvage scoring systerm,statistical analysisof function between the knee of preoperative and postoperative, t=5.973,P=0.002.according to the inspection level0.05,It has statisticaldifference between the knee function of preoperative and postoperative, thefunction of postoperative was better than of preoperative.Application ofunicompartmental knee replacement criteria evaluation system,statisticalanalysis of function between the knee of preoperative and postoperative, t=t=3.501,P=0.017,.according to the inspection level0.05,It has also statisticaldifference between the knee function of preoperative and postoperative, thefunction of postoperative was better than of preoperative. Conclusion：1Borderline tumor resection has lower the recurrence rate, based on the6caseports follow-up, there is no recurrent. However the sample size is small,and a larger sample size and long-term follow-up are needed.2Autologous bone graft has good histocompatibility, no immunereaction, less postoperative complications, and materials easy with wellplasticity, can be suitable to repair single condylar bone defect, singleartificial condyle of tibia provides better joint surface, and prevents theoccurrence of postoperative traumatic arthritis. Knee joint is stability afterreconstruction, postoperative knee function is better than preoperative thoughstatistical analysis by the preoperative and postoperative functional score.3The operation scope is narrow, the cases of demanding.According toCT cross-section, tumor destruction less than half of maximum lateral axis,articular cartilage surface significantly invaded.At the same time, operationpersonnel requirements higher Department of orthopedics technology level,can extend the service life of artificial prosthesis4In following up, the graft bone healed well, no joint collapse andprosthesis loosening, without recurrence, the knee joint function recoveredwell. The operation method is a better treatment of GCT in tibia singlecondyle with articular cartilage damage.5Knee joint movement is relatively complex, its biological modalityafter autologous bone graft corresponding changes, the serving life of artificialcondyle arthroplasty may be unknown, postoperative prosthesis loosening andsubsidence is one of the more common long-term complications, whetherlateral compartment after reconstruction would be changed accordingly, allthese problems still need further clinical observation after a long period.