Abstract
From January 1992 to July 2001, we treated 38 patients with giant cell tumour in the knee region. Seventeen tumours were located in the distal femur and 21 in the proximal tibia .Twenty patients were classified as Campanacci grade II, 15 as grade III, and three as grade I. Patients’ mean age was 34.5 (19–65) years, and the mean follow-up was 52 (24–134) months. Operative procedures were chosen according to the extent of bone and soft-tissue involvement. In 28 patients, intralesional curettage and bone grafting was performed and in ten patients a wide resection. We defined subchondral bone of the knee to be affected when the distance to the tumour was less than 3 mm. We then measured the area of affected subchondral bone radiographically using plain radiographs, CT, and MRI. In patients initially treated with curettage and bone grafting, the mean area of initially affected subchondral bone was 18.6 (0–81)%. The mean Enneking functional score at follow-up was 88 (66.6–100). There was a linear trend showing that the larger the area of affected subchondral bone, the worse the functional score. Among patients initially treated with wide resection, the mean area of affected subchondral bone was 68.2 (41–100)%. There was, however, no significant association between affected subchondral bone area and functional score.
Résumé
De janvier 1992 à juillet 2001, nous avons traité 38 malades avec une tumeur à cellules géantes de la région du genou. Dix-sept tumeurs étaient localisées dans le fémur distal et 21 dans le tibia proximal. Vingt-huit malades ont été classés comme grade II de Campanacci, 15 comme grade III et trois comme grade I. L’âge moyen des malades était de 34.5 (19–65) ans et le suivi moyen de 52 (24–134) mois. Les procédures chirurgicales ont été choisies d’après l’extension osseuse et la participation des parties molles. Vingt-huit malades ont eu un curetage intralésionel et une greffe osseuse et dix malades une résection large. Nous avons considéré l’os sous-chondral du genou atteint quand la distance à la tumeur était de moins de 3 mm. Nous avons mesuré la superficie sous-chondrale affectée par radiographie en utilisant des radiographies ordinaires, la tomodensitométrie et l› IRM. Chez les malades initialement traités par curetage et greffe, la superficie moyenne d’os sous-chondral initialement affecté était de 18.6 (0–81)%. Le score fonctionnel moyen de Enneking au suivi étaitde 88 (66.6–100). Il y avait une tendance linéaire montrant que plus grande est la superficie d’os sous-chondral affecté, moins bon est le score fonctionnel. Parmi les malades initialement traités par résection large, la superficie moyenne d’os sous-chondral affecté était 68.2 (41–100)%. Cependant il n’y avait aucune association significative entre la surface d’os sous-chondral affecté et le score fonctionnel.
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