大段同种异体骨移植在治疗四肢恶性骨肿瘤中的应用研究

Massive allograft for defects after resection of bone malignant tumors

目的 观察大段同种异体骨移植在治疗四肢恶性骨肿瘤切除后骨缺损的疗效。方法 对 130例四肢骨肿瘤 ,切除范围以Enneking分期为原则 ;异体骨移植术式分 :1/4关节、1/2关节、部分骨干、全骨段、全骨段 +人工假体、1/2关节 +自体带血管骨瓣 ;内固定分 :钢板 +螺丝钉、螺丝钉、普通髓内钉、带锁髓内钉 ;疗效按Mankin提出的评定标准 ,将结果分 :优、良、中、差。结果 随访 6～ 15 6个月 ,本组治疗满意率为 6 3.8% ,主要并发症是感染、骨折、骨不愈合 ,其发生率为 39.2 % ,保肢率为 76 .3%。结论 大段同种异体骨移植 ,在治疗四肢恶性骨肿瘤切除后骨缺损方面 ,不失为一种有效可行的方法。其并发症发生与肿瘤外科分期、是否化疗、移植骨大小、受骨区软组织条件好坏。

Objectve To study allograft for defects after bone malignant tumor resection in limb preservation. Methods 130 patients with bone malignant tumor underwent resection following Enneking's system.The types of allograft included 1/2 joint, 1/4 joint, whole bone, partial bone shaft,whole bone allograft+prosthesis,and 1/2 joint+vascularizd bone flap. Internal fixation included a plate+screws, screws, intramedullary nail,and locking intramedullary nail.The results were graded according to Mankin's system as excellent, good, fair,and failure;failure means unsatisfactory. Result The patients were followed up for 6～156 months,with a satisfactory rate of 63.8%.Main complications were infection, non-union and fracture of graft,the rate of complications being 39.2%.The limb preservation rate was 76.3%. Conclusions Massive allograft is a good method for repairing defects after bone malignant tumor resection in limbs. The occurrence of complications is related to surgical stage of tumor, chemotherapy,size of bone allograft,adjacent soft tissue,and internal fixation.