同种异体半关节移植20年以上远期疗效评价

Long-term effect of massive allograft bones implantation on defects:a more than 20 years observation

目的探讨分析同种异体半关节移植的远期疗效及常见并发症。方法回顾性分析应用同种异体半关节移植治疗近关节骨肿瘤切除后遗留大块骨缺损。对随访资料完整、随访时间超过20年的32例进行临床及组织学分析。其中骨巨细胞瘤25例，动脉瘤样骨囊肿1例，硬纤维瘤1例，皮质旁骨肉瘤2例，软骨肉瘤2例，纤维肉瘤1例，均有病理证实。发生于胫骨近端12例，股骨远端14例，股骨近端3例，肱骨近端3例。普通髓内针内固定17例，钢板内固定15例。结果32例患者均得到随访，平均随访时间24．5年（21～28年），异体骨愈合29例，不愈合3例。主要并发症：肿瘤局部复发2例，感染1例，异体骨骨折6例，异体骨吸收3例，关节强直7例。关节功能按Mankin评分标准：优4例，良21例，中1例，满意率81．3％。结论同种异体半关节可以作为长期替代物应用于修复近关节肿瘤切除后骨缺损，骨性关节炎是影响患者远期生活质量的主要并发症。

Objective To explore the long-term effects and complications of large segment allografts in the treatment for hone tumors. Methods A retrospective analysis of 32 consecutive cases, 34 to 72 years old, of large segment allograft implantations following resection of hone tumor was conducted. 25 cases had aggressive giant-cell tumors of hones, 2 had chondrosarcoma and 5 had other bone tumors. The mean length of the grafts was 18.5cm （ranged 10-30cm）. 15 cases received fixation with common intramedullary nailing, 13 with plates, and 4 with screws. Results Followed up from 21 to28 years （average 24.5 years）, 30 cases had union and 2 cases did not. Major complications happened in 2 cases, infection in 1 case, fracture in 6 cases, bone absorption in 3 cases, and arthrokleisis in 7 cases. Based on the Mankin system, 4 cases had excellent results, 21 cases had good results, and 1 case had a fair result. The satisfactory rate was 81.3%. Conclusion Allograft bones implantation is reliable in the long term for repairing the bone deflected in the course of limb salvage following resections of bone tumors. Osteoarthritis is the main complication that affects the long-term quality of life.