立柱式植骨修复胫骨上端骨巨细胞瘤致大块骨缺损

Vertical pillar bone graft in the treatment of massive bone defect caused by giant cell tumor at the upper end of tibia

目的探讨立柱式植骨对胫骨上端大块骨缺损修复的治疗效果。方法本组胫骨上端立柱式植骨患者23例,按Ennecking外科分期,1期2例,2期16例,3期5例。当胫骨平台关节面下能保留一层骨质时,残腔切刮后用髂骨块或腓骨支撑;当肿瘤位于一侧髁侵犯关节软骨或软骨下骨质较薄时,行包括肿瘤在内的一侧髁切除后,用游离髌骨移植修复骨缺损;当肿瘤较大,胫骨平台无法保留时,将胫骨两髁连同髁间部切除后,用髂骨代替两侧胫骨平台,下方用两腓骨支撑,行立柱式植骨修复和重建膝关节部骨缺损。结果随访3个月至9年,平均4.7年,根据国际保肢学会功能评分标准,本组优9例,良13例,可1例。主要并发症为关节轻度疼痛,活动范围减小。结论胫骨上端骨巨细胞瘤切除后的大块骨缺损行立柱式植骨后能获得良好的关节功能。

Objective To study the efficacy of vertical pillar bone graft in the treatment of massive bone defect caused by giant cell tumor at the upper end of tibia. Methods 23 patients underwent vertical pillar bone grafting for the bone defect at the upper end of tibia. According to Ennecking staging system, the tumors were in stage 1 （n=2）, stage 2 （n 161. and stage 3 （n 5）. For patients with a layer of sclerolin preserved under the tibial plateau, after the residual cavity was resected, lilac bones or the tibial bone was used for supporting. For patients with a tumor at one condyle, affecting tbe cartilage or the subchondral sclerotin, resection of the tumor and one condyule would be performed, and dissociated patella bone grafting was used to repair the bone defect. If the tumor was too big, and the tibial plateau could not be preserved, the condyles of tibia and the intercondylar part were resected, and the hip bone was used to replace the tibial plateaus on both sides. The tibias was supported from below, and vertical pillar bone grafting was performed to repair and reconstruct the bone defect in the knee. Results All patients were followed up for 3 months to 9 years, with 4.7 years on average According to the function evaluation system of the International Society of Limb Salvage, the results were excellent （n=9）. good （n=13）, and fair （n=1）. The major complications were mild pain of the joint and reduced range of activity. Conclusions Vertical pillar bone graft for massive bone defect caused by giant cell tumor at the upper end of tibia can help gain good joint function after surgery.