大块同种异体骨移植重建骨肿瘤巨大骨缺损78例

Reconstruction of bone defects with massive bone allograft for bone tumor treatment in 78 cases

回顾性分析1999-08/2007-01解放军广州军区广州总医院骨科收治的骨肿瘤切除后骨缺损患者78例,男47例,女31例,年龄7～56岁,平均21.5岁。其中骨巨细胞瘤34例,骨肉瘤12例,动脉瘤样骨囊肿11例,平滑肌肉瘤2例,腺泡状软组织细胞瘤1例,骨纤维结构不良18例。以Enneking外科分期标准为原则,对肿瘤进行切除。主要发病部为股骨上端,股骨干,股骨下端,胫骨上端,骨盆。重建方式以行大块骨移植63例,骨干移植10例,髂骨移植2例,人工关节-异体骨复合物移植3例。全部患者均获得随访,平均37.9个月。移植后结果以Mankin等所提出的评定标准为原则优36例,良29例,中4例,差9例。出现局部排斥反应18例,予反复抽吸积液及抗排斥反应治疗7～54d后症状消失,肿瘤复发7例,感染4例,骨不连5例,异体骨骨折1例,关节不稳定2例。大块异体骨与宿主骨在移植后1周就可在接合部出现明显的骨痂生成,在接合部和异体骨表面尽量布满细小的异体骨或自体骨可明显加强骨诱导。提示采用大块异体骨重建骨肿瘤术后大的缺损,临床效果良好,取得满意效果。

Retrospective analysis of 78 cases with bone defects after bone tumor resection from the Department of Orthopaedics, Guangzhou General Hospital of Guangzhou Military Command from August 1999 to January 2007 was performed. The patients consisted of 47 male and 31 female, with an average age of 21.5 years （7 to 56 years）. Among them, 34 cases suffered from giant cell tumor of bone, 12 cases from osteosarcoma, 11 cases from aneurysmal bone cyst, 2 cases from leiomyosarcoma, 1 case from alveolar soft-tissue tumor, and 18 cases from bone fibrous dysplasia. Proximal and distal femur, femoral shaft, proximal tibia, and pelvic were the main pathogenic sites. Bone tumor resections were performed according to Enneking＇s surgical staging system. Fresh frozen-allografts for reconstruction included massive bone （63 cases）, long bone （10 cases）, iliac bone （2 cases）, and allograft prosthesis composite （3 cases）. All patients obtained the follow-up with an average of 37.9 months. The results were assessed by the principle of the criteria proposed by Mankin： excellent in 36 cases, good in 29 cases, fair in 4 cases, and poor in 9 cases. There were 18 cases of local rejections, 4 cases of infection, 5 cases of nonunion, 7 cases of recurrence, and 2 cases of joint instability. The formation of bony callus was observed obviously at the graft union between massive allogeneic bone and allogenic bone at 1 week after transplantation. Graft union and allogeneic bone covered by fine allogeneic and allogenic bones could enhance bone induction. The results suggested that reconstruction of large bone defects with massive bone after tumor resection can achieve satisfactory effect.