大段冷冻异体骨移植治疗骨肿瘤

Massive frozen allograft bone implantation for defect after bone tumor resection

目的 :探讨冷冻大段同种异体骨和关节移植治疗骨肿瘤的临床应用及疗效。方法 :回顾分析 1991～ 1999年间 ,应用冷冻保存大段同种异体骨关节治疗骨肿瘤切除后遗留大块骨缺损。随访资料完整的 5 4例 ,其中男 30例 ,女 2 4例 ,年龄 18～71岁 ,平均 42 .5岁 ,异体半关节移植 48例 ,骨段移植 2例 ,异体骨 +人工关节 4例。异体骨移植长度 12～ 2 5 cm。普通髓内钉固定 16例 ,交锁髓内钉固定 18例 ,螺丝钉固定 15例 ,重建钢板固定 2例 ,克氏针 +螺丝钉固定 3例。结果 :5 4例患者平均随访时间 4.5年 (0 .5～ 9年 ) ,异体骨愈合 5 3例 ,不愈合 1例。主要并发症 :肿瘤局部复发 4例 ,感染 4例 ,骨折 2例 ,关节面塌陷3例 ,关节强直 2例。关节功能按 Mankin标准评定 ,优 2 1例 ,良 18例 ,中 8例 ,优良率 87%。结论 :冷冻大段同种异体骨关节移植是修复骨肿瘤切除后骨缺损的有效方法 。

Objective: To study the results of large segment allografts in treatment of bone tumor. Methods: From 1991 to 1999 a retrospective analysis of 54 consecutive cases of large segment allograft implantation after resection of bone tumors was conducted. The allogeneic bone healing were observed. Fifty-four cases had an average age of 42.5 years (ranging 18-71 years). Inter-segmental allograft was performed in 2 cases, osteoarticular allograft in 52 cases, allograft+prosthesis in 4 cases. The mean length of allograft was 15.5 cm (ranging 12-25 cm). The types of fixation included common intramedullary nailing in 16 cases, inter-locking intramedullary nailing in 18 cases, plate in 2 cases, screwn 15 cases. Results: Follow-up ranged from 6 months to 9 years (average, 4.5 years) in 54 cases. Fifty-three cases had union and 1 non-union. The major complications were recurrence in 4 cases, infection in 4, fracture in 2, absorption and collapse of articular surface in 3 cases. The function were evaluated by Mankin system: eighteen cases had excellent results, 21 cases had good, 8 cases fair, the satisfactory rate was 87%. Conclusion: The allograft bones implantation is a desirable graft material for repair of bone defect following resection of bone tumor. Satisfactory results can be obtained with controled indication.