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골의 거대세포종

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 Giant cell tumor of bone 
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[한글] 1992년 3월부터 2001년 3월까지 수술적 치료를 받고, 병리학적으로 골의 거대세포종으로 확진된 환자 중, 최소 2년 이상 추적관찰이 가능하였던 52예를 후향적으로 검토하였다. 본 연구의 목적은 치료결과 및 재발율을 평가하고, 임상적 특성과 치료방법에 따른 재발과의 상관관계 유무를 확인하는 것이었다. 성별 분포는 여자가 33예(63%)로 남자보다 많았고, 평균연령은 30세였으며, 20-40세가 64%를 차지하였다. 평균 추시기간은 4년 4개월이었다. 호발부위는 경골근위부가 16예(31%), 대퇴골원위부가 14예(27%), 상완골근위부가 4예(8%), 요골원위부가 3예(6%), 척추 5예(10%)였다. Campanacci 분류는 1기가 1예(2%), 2기가 22예(42%), 3기가 29예(56%)였다. 병적골절은 7예(13%)에서 진단시 동반되었다. 처음 내원시 재발한 경우는 5예(10%)였다. 다발성 병변 1예와 내원시 폐전이 2예가 있었다. 수술적 치료는 병소내 소파술이 43예(83%), 절제술이 9예(17%)였다. 시멘트 충전술은 38예(73%)에서, 골이식은 6예(12%)에서 시행하였다. 내금속고정물을 사용한 예가 11예(21%)였다. 이중 종양대치물 삽입은 5예였다. 방사선치료와 동맥색전술은 3예씩 있었다. 치료 후 재발은 16예(31%)에서 발생하였다. 재발시기는 평균 1년 5개월이었으며, 1예를 제외하고는 모두 2년내에 재발하였다. 국소재발과 성별, 발생부위, Campanacci분류, 병적골절, 내원시 종양의 재발여부, 절제연, 골이식, 내금속고정, 골시멘트 충전술 등 각 항목은 통계적인 의의를 갖는 상관관계를 보이지 않았다. 재발은 대부분 2-3년내에 발생하므로, 기간내 정기적 추시와 검사를 시행하여야하며, 재발 및 폐전이에 대한 장기적인 추시 관찰이 요구된다.
[영문] Fifty-two patients who had been treated as giant cell tumor of bone from 1992 to 2001 were reviewed. The purpose of this study was to evaluate the rate of recurrence and determine what, if any, patient factors, tumor characteristics, or surgical treatments correlate with local recurrence. There were 33 females(63%) and 19 males(37%). The mean age of the patients was 30 years, 64% of the patients were between twenty and forty. The mean duration of follow-ups was 52 months(range, 24-104months). Sixteen tumors(31%) were in the proximal tibia, 14(27%) in the distal femur, 4(8%) in the proximal humerus, 3(6%) in the distal radius, and 5(10%) in the spine. According to the grading of Campanacci et al, one(2%) had grade 1, twenty-two(42%) had grade 2, twenty-nine(56%) had grade 3. Seven patients(13%) had a pathologic fracture at the time of presentation. Forty-seven were primary tumors and five(10%) were recurrences. There were one multicentric tumor and two pulmonary metastases. Forty-three patients(83%) were managed with intralesional curettage and nine(13%) with en bloc resection. Cement was used in 38 patients(73%) and bone graft was done in 6 patients(12%). Eleven patients(21%) had internal fixations including 5 prosthesis. Radiation therapy or arterial embolization were conducted in 3 cases, each. Sixteen patients(31%) had a local recurrence. The average time to recurrence was 17 months. All but one recurrence occurred within 2 years after the index surgical treatment. There was no significant difference in recurrence rates based on the following variables : patient gender, tumor location, Campanacci grading, pathologic fracture, primary versus recurrent tumor on presentation, margin of resection, or the use of bone graft, internal fixation, polymethylmethacrylate. Most recurrences of giant cell tumor can be expected within the first two or three years, therefore the patients should be followed in the period and longer for the late recurrence and pulmonary metastases.
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