【摘要】 目的 回顾性分析髌骨骨巨细胞瘤的临床表现、影像表现及采取的外科治疗措施，以探讨合理的手术方式以及对患者术后肿瘤学评估结果和患肢功能的影响。方法 回顾性分析2008年1月至2021年12月在北京积水潭医院接受手术治疗的髌骨骨巨细胞瘤15例，其中男性8例，女性7例，平均年龄25.9岁(范围：13～50岁)。术前根据影像学检查评估肿瘤的范围、边界、对骨质的破坏程度以及周围可保留的正常骨量情况，制定手术方案，采用保留髌骨的肿瘤刮除或去除髌骨的肿瘤切除。刮除后采用植骨或骨水泥填充骨缺损。髌骨切除后应用人工韧带重建伸膝装置。结果 手术方式包括整块切除6例和病灶刮除9例。术后随访12～117个月，中位随访31个月。术后复发2例(13.3%),均为肿瘤刮除术后复发。Kaplan-Meier生存分析显示5年无复发生存率为91.9%。手术外科边界为囊内边界的术后复发率为22.2%(2/9),边缘和广泛边界的术后复发率为0(0/6),两组差异无统计学意义(P>0.05)。复发病例和原发病例的术后复发率分别为33.3%(1/3)和8.3%(1/12),两组差异无统计学意义(P>0.05)。CampanacciⅡ级和Ⅲ级患者的复发率分别为16.7%(1/6)和11.1%(1/9),两组差异无统计学意义(P>0.05)。结论 刮除手术可保留髌骨结构和功能，但有一定的术后复发风险。对于肿瘤累及广泛或复发的病例，建议行切除手术，可通过人工韧带和肌瓣重建伸膝装置，使患者获得较为接受的术后功能。更多还原

【Abstract】 Objective The clinical manifestations, imaging manifestations and surgical treatment of giant cell tumor of patella were retrospectively analyzed in order to explore the reasonable surgical methods and the influence on the results of postoperative oncological outcome and the function of the affected limb. Methods A retrospective study was conducted on 15 patients with patellar giant cell tumors who underwent surgical treatment in Beijing Jishuitan Hospital from January 2008 to December 2021, including 8 males and 7 females, with an average age of 25.9(13-50) years. The extent, boundary, degree of bone damage to the tumor, and the surrounding normal bone mass was evaluated based on imaging examinations pre-operative. The surgical plan was developed with patellar preserved tumor curettage or patellar removed tumor resection. The bone grafting or bone cement is used to fill the bone defect after tumor curettage. Reconstruction of knee extension device was performed with artificial ligament after patellar resection.Results The surgical methods included en-block resection in 6 cases and tumor curettage in 9 cases. The average postoperative follow-up time was 38.7(median 31, 12-117) months. Two cases(13.3%) experienced postoperative recurrence and both of which were after tumor curettage. The Kaplan-Meier method analysis showed a 5-year recurrence free survival rate of 91.9%. The postoperative recurrence rate of the intracapsular boundary was 22.2%(2/9) and the postoperative recurrence rate of the margin and wide boundary was 0(0/6), with no statistically significant difference between two groups(P>0.05). When visiting our hospital, the postoperative recurrence rate of recurrent cases and primary cases were 33.3%(1/3) and 8.3%(1/12) respectively, with no statistically significant difference between two groups(P>0.05). The recurrence rates of Campanacci stage 2 and stage 3 cases were 16.7%(1/6) and 11.1%(1/9) respectively, with no statistically significant difference between two groups(P>0.05). Conclusion The tumor curettage surgery can preserve the structure and function of the patella, but there is a certain risk of postoperative recurrence. For cases with extensive or recurrent tumor involvement, it is recommended to undergo resection surgery. Artificial ligaments and muscle flaps can be used to reconstruct the knee extension device, allowing patients to achieve acceptable postoperative function.更多还原