同种异体骨植骨联合锁定加压钢板治疗四肢良性骨肿瘤及类瘤病变的随访研究

Allografting and locked compression plating in treatment of benign bone tumors and tumor-like lesions of the extremity:a follow-up study

目的 探讨同种异体骨植骨联合锁定加压钢板治疗四肢良性骨肿瘤的临床疗效和安全性。 方法 回顾性分析2005年3月至2011年3月本科收治的56例接受同种异体骨植骨联合锁定加压钢板手术治疗的四肢良性骨肿瘤及类瘤病变病例患者的临床资料。其中男性31例，女性25例，年龄10～61（38.7±3.6）岁；疾病类型：单纯骨囊肿 16例，骨纤维结构不良15例，动脉瘤样骨囊肿10例，骨巨细胞瘤9例，骨母细胞瘤3例，嗜酸性肉芽肿3例，其中合并病理性骨折36例，均行病灶刮除、同种异体骨植骨、锁定加压钢板内固定治疗，观察植骨量、有无免疫排斥反应、植骨愈合情况、愈合时间、病灶有无复发等。 结果 本组病例植骨量为（23.5±10.3）g，随访时间12～60（25.5±12.3）个月，5例失访。2例骨巨细胞瘤复发，余49例均获治愈，4例出现排异反应，平均骨愈合时间为6个月，术后1年根据骨骼愈合情况取出内固定，未出现骨不连及再骨折情况。 结论 同种异体骨促进成骨、修复骨缺损效果确切，排异反应发生率低，在彻底刮除病变的前提下，与锁定加压钢板联合应用可有效治疗四肢长骨良性骨肿瘤及类瘤病变。

Objective To determine the clinical efficacy and safety of allografting and locked compression plating in the treatment of benign bone tumors and tumor-like lesions of the extremity. Methods From March 2005 to May 2011, 56 patients in our department underwent radical curettage, allograft bone transplantation and locked compression plate fixation for benign bone tumors and tumor-like lesions of the extremity. They were 31 males and 25 females with a mean age of 38.7±3.6 years （ranging from 10 to 61 years）. The types of primary tumors in these patients were bone cyst in 16 patients, bone fibrous dysplasis in 15, aneurysmal bone cyst in 10, bone giant cell tumor in 9, osteoblastoma in 3 and eosinophilic granulomatosis in 3 patients. Pathological fracture occurred in 36 patients. The volume of allograft bone, immunological rejection, bone reconstruction, healing time, and tumor recurrence were reviewed and analyzed. Results Besides 5 patients were lost for follow-up, the cohort of patients was followed up for a mean duration of 25.5±12.3 months （ranging from 12 to 60 month）. The median bone mass were 23.5±10.3 g. Two patients had recurrence of bone giant cell tumor, and the others were cured totally. Four patients had complications as immunological rejection, with a mean bone healing time of 6 months. In 1 year after the first surgery, internal fixation was removed according to their bone healing, and no nonunion or re-fracture was observed. Conclusion Allograft bone implantation shows definite efficiency in promoting osteogenesis and repairing bone defect, with no obvious immunological rejection. It combined with locked compression plate, can be used to treat the benign bone tumors and tumor-like lesions of the extremity after curettage of lesions.