Objective： To evaluate the functional outcome and complications of allograft replacement in management of bone tumors. Methods： Between March 1992 and September 2002, 164 patients underwent bone tumor resection and ...Objective： To evaluate the functional outcome and complications of allograft replacement in management of bone tumors. Methods： Between March 1992 and September 2002, 164 patients underwent bone tumor resection and massive allograft reconstruction of bone defects. The length of the resected part ranged from 5-35 cm. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular grafts （n = 95）, hemi-condylar （n = 15）, massive （n = 23）, allograft-prosthesis composite （n = 12）, intercalary grafts （n = 15） or hemi-pelvic grafts （n = 4）. Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, proximal tibia and humerus. Results： At a median follow-up of 47 months （range, 12 to 168 months） after the operation, 154 of the patients in the study were free of disease and 10 died of disease. Twenty-one （12.8%） patients had local recurrence and 38 （23.2%） nonunion. Late complications included 11 （6.7%） fractures of the allograft and 18 （11.0%） infections of the graft, instability of the joint in the form of subluxation was noted in 13 （7.9%） patients. Ten extremities were amputated due to local recurrence or severe infection. Conclusion： AIIografts can be used for reconstruction of bony defects after tumor resection. AIIograft has nearly similar shape, strength, osteo-inductivity and osteo-conductivity with host bone. AIIograft implantation is a high complication reconstruction method, and the dsk of recurrence increases when less surgical margin achieves.展开更多
Objective To Investigate stress adaptability of freeze-dried bone allograft.Methods Cortical and cancellous allograft were transplanted to each side of the midshaft diaphyseal ulna in two groups of 28 animals.The left...Objective To Investigate stress adaptability of freeze-dried bone allograft.Methods Cortical and cancellous allograft were transplanted to each side of the midshaft diaphyseal ulna in two groups of 28 animals.The left transplanted allograft was free from fixation and bore a normal physiological lcad,while the right transplanted allograft was protected from loading by a simple external fixator and bore less load.Animals were sacrificed at the 2nd,4th,8th,16th week after transplantation and specimens were taken out for bone histomorphometry studies and analysis of collagen gene expression by in situ Cdna-Mrna hybridization.Results Labeled surface(LS)and bone mineral apposition rate(MAR)of the normally loaded graft-host bone interface were significantly higher than that of the less loaded side at the 4th,8th,16th week after transplantation.Parameters reflecting the internal repair process of the allograft,such as LS in cortical and cancellous bone or MAR in cortical bone of the normally loaded side were significantly higher than those of the less loaded side at the 16th week after transplantation.The result of in situ hybridization indicated that more osteoblast-like cells expressing the type Ⅰ collagen gene were found in the interface or interior of normally loaded grafts.Conclusion The stimulus of physiologic load can accelerate the early union of allograft-host bone interface and later new bone creep substitution to the necrotic allograft.展开更多
文摘Objective： To evaluate the functional outcome and complications of allograft replacement in management of bone tumors. Methods： Between March 1992 and September 2002, 164 patients underwent bone tumor resection and massive allograft reconstruction of bone defects. The length of the resected part ranged from 5-35 cm. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular grafts （n = 95）, hemi-condylar （n = 15）, massive （n = 23）, allograft-prosthesis composite （n = 12）, intercalary grafts （n = 15） or hemi-pelvic grafts （n = 4）. Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, proximal tibia and humerus. Results： At a median follow-up of 47 months （range, 12 to 168 months） after the operation, 154 of the patients in the study were free of disease and 10 died of disease. Twenty-one （12.8%） patients had local recurrence and 38 （23.2%） nonunion. Late complications included 11 （6.7%） fractures of the allograft and 18 （11.0%） infections of the graft, instability of the joint in the form of subluxation was noted in 13 （7.9%） patients. Ten extremities were amputated due to local recurrence or severe infection. Conclusion： AIIografts can be used for reconstruction of bony defects after tumor resection. AIIograft has nearly similar shape, strength, osteo-inductivity and osteo-conductivity with host bone. AIIograft implantation is a high complication reconstruction method, and the dsk of recurrence increases when less surgical margin achieves.
文摘Objective To Investigate stress adaptability of freeze-dried bone allograft.Methods Cortical and cancellous allograft were transplanted to each side of the midshaft diaphyseal ulna in two groups of 28 animals.The left transplanted allograft was free from fixation and bore a normal physiological lcad,while the right transplanted allograft was protected from loading by a simple external fixator and bore less load.Animals were sacrificed at the 2nd,4th,8th,16th week after transplantation and specimens were taken out for bone histomorphometry studies and analysis of collagen gene expression by in situ Cdna-Mrna hybridization.Results Labeled surface(LS)and bone mineral apposition rate(MAR)of the normally loaded graft-host bone interface were significantly higher than that of the less loaded side at the 4th,8th,16th week after transplantation.Parameters reflecting the internal repair process of the allograft,such as LS in cortical and cancellous bone or MAR in cortical bone of the normally loaded side were significantly higher than those of the less loaded side at the 16th week after transplantation.The result of in situ hybridization indicated that more osteoblast-like cells expressing the type Ⅰ collagen gene were found in the interface or interior of normally loaded grafts.Conclusion The stimulus of physiologic load can accelerate the early union of allograft-host bone interface and later new bone creep substitution to the necrotic allograft.
