大段异体骨移植治疗骨干肿瘤

Segmental allograft reconstruction for diaphyseal bone tumors

目的探讨大段异体骨移植治疗肢体长管状骨骨干肿瘤节段性切除后骨缺损的疗效。方法1995年7月至2006年7月应用此方法治疗骨原发良恶性肿瘤45例,资料完整者26例,胫骨13例,股骨7例,肱骨6例。按照Enneking分期,恶性肿瘤行边缘切除或广泛切除,部分行新辅助化疗。大段同种异体骨采用深低温冷冻保存,异体骨长度平均1 2.2cm,钢板螺丝钉或交锁髓内钉固定。结果随访14个月至13年,平均64.1个月。3例死亡,2例复发,2例感染。总骨端愈合率为66.7%,愈合时间平均15.7个月。截骨面位于松质骨者,愈合率为84.6%,愈合时间平均9.6个月。骨端不愈合者中,2个端为钢板螺丝钉固定(14.3%),12个端为交锁髓内钉固定(40%)。异体骨骨折1例(4.2%)。术后功能评定采用MSTS评分,上肢21～28分,平均25.6分;下肢19～27分,平均24.8分。结论大段异体骨移植与宿主骨愈合后,在内固定的支持和协同作用下,有望长期甚至终身使用。在坚强内固定的支持下,较长时间的等待会增加骨端愈合率。不愈合患者通过接触端再植骨后,仍有较高的愈合机会。

Objective To evaluate the outcome of segmental allograft reconstruction for long diaphyseal defects after tumor resection. Methods Between July 1995 and July 2006, 45 patients underwent segmental allograft reconstruction for long bone tumors. Complete clinical and follow-up data of 26 cases was available. Tumor was located at tibia （n=13）, femur （n=7）, and humerus（n=6）. According to Enneking staging system, marginal or wide resection was performed for malignant bone tumors. Some patients received new adjuvant chemotherapy. Segmental allograft was preserved by deep fresh freezing, and the average length was 12.2 cm. Operation of internal fixation with plate screw or interlocking intramedullary nail was performed. Results At a mean follow-up of 64.1 months （ranging from 14 months to 13 years）, 3 patients died, 2 patients underwent relapse, and 2 patients developed bone infection. Bone union rate was 66.7% with the mean healing time of 15.7 months. Bone union rate was 84.6% with the mean healing time was 9.6 months when the osteotomy surface was cancellous bone. Two patients with plate screw fixation and 12 with interlocking intramedullary nail underwent bone nonunion with the non-union rate of 14.3% and 40%, respectively. The mean MSTS score was 24.8, 21 to 28 for upper limbs and 19-27 for lower limbs. Conclusions Segmental allograft is one of the main reconstruction methods for long bone defects after tumor resection. It could be long-time or even perpetually used after bone union with the advantage of abundance of bone and multiple choices that could be supplied. Compared to other kinds of allograft transplantation, bone union is the primary problem and should be mostly cared. Bone union rate could be increased with strong internal fixation and more time supplied. For those patients underwent bone nonunion, high possibility of bone union could also be gained after bone grafting in the conjunction.