带血管蒂腓骨联合骨移植重建恶性肿瘤切除后的股骨干连续性

Vascularized fibula autograft combined bone graft for reconstruction of femoral shaft continuity after resection of malignant tumor

目的探讨平行重建钛缆固定和同心圆重建接骨板固定在恶性肿瘤切除后股骨连续性重建中的作用。方法回顾性分析2013年9月至2017年12月连续收治并获得随访的11例恶性肿瘤切除术后股骨干骨缺损、不愈合或骨折患者, 男10例、女1例;年龄(27.1±15.6)岁(范围7~49岁)。包括股骨干恶性肿瘤一期切除及骨缺损重建6例, 股骨恶性肿瘤大段异体骨移植术后接骨端不愈合或异体骨骨折4例, 大腿软组织肉瘤切除术后放疗致股骨骨折1例。采用带血管蒂游离腓骨联合大段异体骨或灭活骨移植进行重建:将腓骨放置于股骨和异体骨内侧, 以钛缆固定(平行重建组);或将腓骨放置于异体骨或灭活骨的髓腔中, 以接骨板和螺钉固定(同心圆重建组)。结果平行重建组5例, 接骨端或骨折端7个;腓骨移植长度(15.0±4.3)cm(范围10~20 cm);随访时间(33.2±15.6)个月(范围20~53个月)。同心圆重建组6例, 接骨端或骨折端10个;腓骨移植长度(15.5±2.3)cm(范围12~18 cm);随访时间(45.8±15.3)个月(范围22~62个月)。两组随访时间的差异无统计学意义(t=1.36, P=0.208)。平行重建组接骨端或骨折愈合率100%(7/7), 愈合时间(15.9±6.8)个月(范围3~22个月);同心圆重建组接骨端或骨折愈合率70%(7/10), 愈合时间(18.9±6.4)个月(范围11~30个月);两组愈合率(P=0.228)、愈合时间(t=0.85, P=0.414)的差异均无统计学意义。结论带血管蒂腓骨平行重建钛缆固定和同心圆重建接骨板固定均为重建恶性肿瘤切除后股骨干连续性的有效术式, 两种重建方式的愈合率和愈合时间无差异。

Objective To investigate the effects of parallel reconstruction with titanium cable fixation and concentric reconstruction with plate fixation in the reconstruction of femoral shaft continuity after resection of malignant tumor.Methods From September 2013 to December 2017,the data of 11 consecutive patients with thigh malignancies and related complications were retrospectively analyzed,including 10 males and 1 female.The mean age of the 11 patients was 27.1±15.6 years(range,7-49 years).These case series included 6 cases of primary bone defect reconstruction after resection of femoral shaft malignant tumor,4 cases of nonunion or allogeneic bone fracture after massive bone allograft for femoral malignant tumor,and 1 case of femoral fracture caused by radiotherapy after resection of thigh soft tissue sarcoma.Vascularized fibular autograft combined with massive bone allograft or devitalized bone graft was used for reconstruction.The patients were divided into two groups according to reconstruction method,namely parallel reconstruction group and concentric reconstruction group.In the parallel reconstruction group,the vascularized fibula was placed on the medial side of the femur and the allograft and fixed with titanium cable.In the concentric reconstruction group,the vascularized fibula was placed in the medullary cavity of the allogeneic bone or devitalized bone and further fixed with the plate and screws.Results There were 5 patients with 7 allograft-host junctions or fracture were treated with parallel reconstruction.The grafted length of fibula was 15.0±4.3 cm(range,10-20 cm).The follow-up duration was 33.2±15.6 months(range,20-53 months).Six patients with 10 allograft-host junctions were treated by concentric reconstruction.The grafted length of fibula was 15.5±2.3 cm(range,12-18 cm).The follow-up duration was 45.8±15.3 months(range,22-62 months).There was no significant difference during follow-up between the two groups(t=1.36,P=0.208).The union rate in parallel reconstruction group was 100%(7/7),and the union duration was 15.9±6.8 months(range,3-22 months).The union rate in the concentric reconstruction group was 70%(7/10),and the union duration was 18.9±6.4 months(range,11-30 months).There was no significant difference in the union rate(P=0.228)or the union duration(t=0.846,P=0.414)between the two groups.Conclusion Both parallel reconstruction and concentric reconstruction of vascularized fibular autograft are important methods for reconstruction of femoral shaft continuity after resection of malignant tumor.There might be no significant difference in union rate or union duration between the two methods.