Intralesional curettage and wide excision for treatment of giant cell tumors (GCTs) of the distal radius: A Meta-analysis / 中国骨伤

ABSTRACT

<p><b>OBJECTIVE</b>To search all studies that had been published in the world with regarding to the effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complications and comparative functional outcomes in patients with giant cell tumours (GCT) of the distal radius and analyze them which were in high quality by means of Meta analysis, in order to give some evidences for the choice of method dealing with giant cell tumors GCT in surgery.</p><p><b>METHODS</b>Cochrane central register of controlled trials(Issue 8 2014), PubMed(1970-01-01/2013-01-01), Ovid (1970-01-01/2013- 01-01), Elsevier (1970-01-01/2013-01-01), CNKI (1970-01-01/2013-01-01) were searched. Including intralesional curettage and wide excision were performed to treat giant cell tumors (GCTs) of the distal radius in the literatures, selecting on meet eligibility in the standard literatures underwent strict quality assessment. The Meta-analysis was performed with software RevMan5.0 from the Cochrane collaboration. Additionally, the analysis checked the heterogeneity of data. The effectiveness of the extent of intralesional curettage and wide excision for recurrence rate and complication in patients with giant cell tumours of the distal radius were evaluated and Odds Ratio was calculated.</p><p><b>RESULTS</b>Seven relevant articles were identified involving total 163 cases. Among them, 92 cases were intralesional curettage (PMMA, n = 54; bone graft, n = 33; no PMMA or bone grafts, n = 5) and 71 cases were wide excision. The patients in the intralesional curettage group had a higher recurrence rate [OR = 3.87, 95% CI (1.42, 10.53)],especially for Campanacci grade 3 GCTs [OR = 10.12, 95% CI (1.57, 65.27)], yet fewer major complications [OR = 0.13, 95% CI (0.04, 0.40)] than the wide excision group. The use of PMMA versus bone graft did not affect the recur- rence rate [OR = 0.96, 95% CI (0.26, 3.56)]. By selecting the system evaluation of MSTS, the VAS and dynamometer, the result showed that the intralesional curettage group was equivalent or preferable to wide excision in terms of function rehabilitation.</p><p><b>CONCLUSION</b>Based on data obtained from the limited number of studies available, intralesional curettage appears to be moreappropriate for the treatment of local lesions (Grade 1 and 2) than Grade 3 GCTs of the distal radius. Moreover, PMMA was not additionally effective as an adjuvant, the intralesional curettage group was found to be equivalent or preferable to wide excision in terms of function rehabilitation.</p>