同种异体骨移植重建四肢恶性骨肿瘤切除后骨缺损

Segmental bone allograft for reconstruction of massive bone defect secondary to malignant bone tumor resection

[目的]探讨同种异体骨移植修复重建四肢恶性骨肿瘤切除后骨缺损的临床疗效。[方法] 2013年6月～2017年12月对本院收治的21例四肢恶性骨肿瘤切除后骨缺损病例进行大段同种异体骨移植重建,其中复合肿瘤型人工关节置换12例,单纯异体骨段移植9例。本组病例男13例,女8例;年龄11～51岁,平均(21.53±6.54)岁,均经过术前穿刺活检及术后病理确诊,Enneking分期ⅠB期4例,ⅡB期17例,其中骨肉瘤和尤文肉瘤患者术前均行2个疗程新辅助化疗及术后规范化疗。术后采用MSTS评分进行功能评价。[结果]所有患者获随访8～48个月,平均(29.64±11.22)个月,均未发生移植异体骨或假体周围骨折,无关节脱位及假体松动。其中19例肢体功能优良,MSTS功能评分16～28分,平均(22.82±4.47)分。[结论]异体骨移植联合肿瘤型人工关节复合置换,以及异体骨段移植重建长骨干缺损仍然是治疗四肢恶性骨肿瘤切除后骨缺损的一种有效重建方法。

[Objective] To explore the significance and outcome of segmental bone allograft for reconstruction of massive bone defect secondary to malignant bone tumor resection.[Methods] Between June 2013 and December 2017,21 patients,including 13 males and 8 females aged 11~51 years with an average of(21.53±6.54) years,underwent segmental bone allografting for reconstruction of massive bone defect secondary to en bloc resection of malignant bone tumor,which contained segmental bone allograft combined with megaprothesis in 12 patients and intercalary bone allograft only in 9 patients.The diagnosis was verified by preoperative puncture biopsy and postoperative pathologic examination,which proved Enneking stage IB in 4 cases and IIB in 17 patients.Of them,the patients with osteosarcoma and Ewing sarcoma received the standard adjuvant chemotherapy for 2 weeks before operation,and continued after the operation.The functional outcome was evaluated by using the MSTS system.[Results] All the 21 patients were followed up for 8~48 months with an average of(29.64±11.22) months.No allograft or periprosthetic fracture,dislocation or loosening was observed in anyone of those patients.At the latest follow up,19 patients achieved good functional results with MSTS score of(22.82±4.47) on average(range 16~28).[Conclusion] The segmental bone allograft combined with megaprothesis or intercalary bone allograft only is an effective reconstruction technique for massive bone defect secondary to malignant bone tumor resection.