四肢骨肿瘤大段同种异体骨移植术后骨愈合的分析

The related factors for bone healing of segmental allografts

目的探讨四肢骨肿瘤大段同种异体骨移植后骨愈合的相关影响因素。方法回顾性分析2007年5月-2016年1月在郑州大学附属肿瘤医院接受大段同种异体骨移植术治疗,并且未出现肿瘤复发转移的17例骨肿瘤患者的临床资料。其中男9例、女8例,年龄11~45岁。手术部位:股骨9例,肱骨6例,胫骨2例。异体骨长度8-28(16.8 ±4.0)cm,内固定方式:钢板螺钉8例,髓内针9例。根据异体骨愈合情况分为未愈合组10例(其中异体骨骨折4例、异体骨感染2例),愈合组7例。分析两组间性别、年龄、手术部位、内固定方式、异体骨长度、是否化疗、术后是否异体骨感染等临床特征的差异。结果17例患者均获随访,随访时间2~10年。骨愈合组7例的平均骨愈合时间为27个月(15-43个月)。未愈组与愈合组患者内固定方式比较,差异有统计学意义(P=0.015);其他临床特征比较,差异均无统计学意义(P值均〉0.05)。结论髓内针固定是大段异体骨愈合的不利因素。

Objective To evaluate the clinical efficacy of reconstruction with segmental allografts in the treatment of bone tumors, and to analyze the related factors affecting the bone healing of the allografts. Methods The clinical data of 17 patients with bone tumors who received large allograft bone grafting in the Affiliated Tumor Hospital of Zhengzhou University from May 2007 to January 2016 were retrospectively analyzed. The 17 patients included 9 males and 8 females. The patients were aged from 11 to 45 years. Surgical site: 9 patients of femur, 6 patients of humerus, 2 patients of tibia. Bone length: 8 cm to 28 cm, mean ( 16. 8 ±4.0) cm. Internal fixation: 8 patients of steel plate screws, 9 patients of intramedullary needles. According to the situation of allograft healing, 10 patients were divided into the unhealed group (including 4 patients of allograft fracture, 2 patients of allograft infection ) and 7 patients in the healing group. The differences of gender, age, surgical site, internal fixation, length of allogeneic bone, chemotherapy and postoperative allogeneic bone infection between the two groups were compared. Results The follow-up period was 2-10 years. Ten patients had bone nonunion (including 4 patients with allograft fracture, 2 patients with allograft infection). The rest seven patients achieved bone union. The average union time was 27 ( 15 -43 ) months. Compared with the unhealed group and the healing group, there was statistical difference in the internal fixation mode between the two groups ( P = 0. 015). There were no statistical differences in the other clinical features( all P values > 0. 05 ). Conclusions The intramedullary nail fixation is an unfavorable factor for the bone healing after allograft reconstruction.