冷冻大段同种异体骨移植四肢骨肉瘤保肢治疗55例临床分析

Clinical Analysis on 55 Cases of Osteosarcoma in Limbs Salvaged with Massive Frozen Allografts Transplantation

目的：观察冷冻大段同种异体骨移植保肢治疗四肢骨肉瘤的临床疗效。方法：1997年6月-2005年7月收治55例四肢骨肉瘤患者，采用肿瘤广泛边缘性切除、太段冷冻同种异体骨移植修复重建骨缺损的保肢治疗，其中股骨42例，胫骨11例，肱骨2例。按Enneking分期，ⅠB期5例，ⅡA期9例，ⅡB期39例，Ⅲ期2例。术前术后联合化疗27例，单一药物化疗者22例，未化疗者6例。结果：55例患者中49例随访1-8年，平均5年5个月。术后持续无瘤存活19例，局部复发5例，术后出现肺或其他部位转移25例，死亡加例，2年存活率为83．7％，3年存活率为71．4％，5年存活率为59．2％。除5例不愈合外，异体骨与宿主骨间均达骨性愈合，愈合率为89．8％，愈合时间5．24个月，平均7．8个月。3例异体骨关节移植患者发生异体骨骨折，骨折率为6．1％。Marlkin分级法评估肢体功能，术后5年随访在可评估的29例病员中，优8例（27．6％），良n例（37．9％），一般2例（6．9％），失败8例（27．6％），优良率为65．5％。结论：冷冻大段同种异体骨完全成活困难，但异体骨与宿主骨间较易愈合而达到永久性生物连接，目前仍是四肢骨肉瘤保肢术的较为理想的方法。

Objective： To observe the clinical effect of massive frozen allografts transplantation treating osteosarcoma for limb salvage. Methods： From June 1997 to July 2005, 55 patients with osteosarcoma in limbs underwent wide local resections of tumor and massive frozen allograft reconstructions for bone defect, 42 femurs, 11 tibias and 2 humeri of total. According to Enneking＇ s classification, there were 5 patients with Stage Ⅰ B, 9 with Stage ⅡA, 39 with Stage ⅡB and 2 with Stage Ⅲ. Twenty - seven patients received preoperative chemotherapy and postoperative chemotherapy, 22 received single medicine chemotherapy and 6 did not receive chemotherapy. Results： Forty- nine of 55 patients were followed up from 1 to 8 years with an average of 5 years and 5 months. Nineteen cases are continuously disease free, local recurrence was found in 5 cases, 25 cases had pulmonary metastatic lesions or other location, 20 cases died. Survival rate for 2 years is 83.7%, survival rate for 3 years is 71.4% and survival rate for 5 years is 59. 2%. Healing was got between allograft and host bone except for 5 patients, the rate of bone healing was 89.8 % and the time of bone healing was 5 to 24 months with an average of 7.8 months. Fracture occurred in 3 osteoarticular allografts and fracture rate was 6. 1%. Among appreciable 29 patients at the latest followup, 8 was rated excellent （27.6%）, 11 was rated good （37.9%）, 2 was ratedfair （6.9% ） and8 was rated failure （27.6%） according to the Mankin scale., 65.5% of all were rated good or excellent. Conclusion： Total survival of massive frozen allograft is dfficult, but healing is easily gotten between allngraft and host bone to obtain permanent biological connection, so massive frozen allografts transplantation is still a fairly ideal method for salvage of osteosarcoma in limbs.