同种异体骨复合人工关节置换治疗骨肿瘤

目的：探讨分析同种异体同关节复合人工假体移植治疗骨肿瘤的临床应用及疗效。方法：对应用同种异体骨关节复合人工假体移植治疗骨肿瘤12例进行临床回顾分析。其中髋关节周围7例，膝关节周围3例，肩关节周围（肱骨近端）2例，病变性质；骨巨细胞瘤6例，皮质旁骨肉瘤2例，软骨肉瘤2例，转移性腺癌2例，均行肿瘤切除及异体骨关节复合人工假体移植。结果：本组12例病人手术均顺利，肿瘤获彻底切除，平均随访时间2．5年（1－5年），伤口均一期愈合无1例感染，关节功能按Mankin标准评定，优良率为91．6％，结论：同种异体骨关节复合人工假体移植是修复骨肿瘤的有效手段。     

冷冻异体半关节移植治疗四肢骨巨细胞瘤

目的：探讨分析冷冻大段同种异体骨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。就随访资料完整,且随访时间超过1年的48例进行临床分析。48例中男28例,女20例,年龄18－46岁,平均34．5岁,初发骨巨细胞瘤36例,复发骨巨细胞瘤12例,异体骨移植长度8－20cm。普通髓内钉固定16例,交锁髓内钉固定13例,螺栓固定19例。结果：48例患者得到随访,平均随访时间4．5年（2－9年）,结果异体骨愈合47例,不愈合1例,主要并发症：感染2例,骨折2例,关节面塌陷关节强直2例,关节功能按Mankin标准评定,本组优18例,良23例,中4例,差3例,治疗满意率93．7％。结论：冷冻大段册种异体骨关节移植是修复骨巨细胞瘤切除后骨缺损的有效手段,但应严格掌握其适应证。     

大段异体骨移植治疗骨肿瘤

目的 探讨大段异体骨移植在骨肿瘤保肢治疗中的临床疗效。方法 回顾观察了 1991年 9月～ 1998年 10月,应用大段异体骨修复 79例骨肿瘤患者瘤段骨切除后骨缺损的治疗情况。男 55例,女 24例;年龄 9～ 70岁,平均 28.8岁。骨肉瘤 38例,恶性骨巨细胞瘤 12例,其他肿瘤 29例。骨段移植 24例,半关节移植 50例,复合人工关节移植 5例。植入异体骨长度 8～ 22 cm,平均 13.5 cm。非交锁型髓内钉固定 16例,交锁型髓内钉固定 53例,钢板固定 5例,复合人工关节移植 5例。结果 67例患者得到随访,时间 5个月～ 7年,平均 2.8年,结果异体骨愈合 62例,不愈合 5例。主要并发症 :复发 8例,感染 8例,骨不连 5例,骨折 4例,内固定失败 4例,关节面吸收塌陷 7例。功能按 Mankin标准评定 :优 25例,良 23例,中 11例,差 8例。结论 大段异体骨移植是一种修复骨肿瘤瘤段切除后骨缺损的有效手段;牢固的髓内固定有利于异体骨愈合。     

腓肠肌内侧肌瓣在胫骨上段恶性肿瘤切除保肢术中的应用

目的探讨腓肠肌内侧肌瓣在胫骨上段恶性肿瘤切除保肢术中的临床疗效。方法2001年1月-2005年9月,利用腓肠肌内侧肌瓣移位修复胫骨上段恶性骨肿瘤切除后的软组织缺损13例,其中男8例,女5例;年龄14-57岁,中位数29.7岁。成骨肉瘤4例,骨恶性纤维组织细胞瘤6例,尤文瘤、滑膜肉瘤、恶性骨巨细胞瘤各1例,病程3-16个月。按照Enneking分期B1例,A9例,B3例。术前行新辅助化疗1-2个疗程。术中行外科边缘切除肿瘤组织及其边界外3cm骨骼及肌肉组织,7例定制人工全膝关节假体置换;2例同种异体移植骨-人工全膝关节复合置换;4例长段同种异体骨移植重建骨缺损。制备带血管蒂的腓肠肌内侧头肌瓣覆盖胫骨假体或移植骨表面,腓肠肌内侧头的肌筋膜与髌腱缝合重建伸膝装置,同时将关节囊、内侧副韧带、绳肌腱止点近端与肌瓣近端缝合,肌瓣远端与胫骨前肌筋膜缝合。结果术后13例均获随访7-47个月。中位随访时间为19.2个月。全部患者伤口均期愈合,无感染、皮瓣坏死、假体/移植骨外露、移植骨骨折、骨不连等并发症。1例恶性纤维组织细胞瘤,因全身转移,术后20个月死亡;1例尤文瘤,术后18个月局部肿瘤复发,行复发病灶刮除加骨水泥填塞,术后26个月肺转移;1例成骨肉瘤术后12个月,肿瘤复发行截肢术。术后下肢功能按Mankin标准评定优6例,良4例,差3例。患者术后满意率77%。结论胫骨上段恶性骨肿瘤切除的保肢术中,采用腓肠肌肌瓣移位可修复软组织缺损,降低局部并发症,提高临床治疗效果。     

儿童长骨骨巨细胞瘤诊断及外科治疗

[目的]研究儿童四肢长骨骨巨细胞瘤的发病，评价不同手术方式的效果。[方法]对1994年12月～2003年12月本院收治的骨巨细胞瘤患者进行统计分析，根据Enneking分级系统分级，Ⅰ-Ⅱ级采用肿瘤刮除，氯化锌烧灼残腔，双氧水浸泡和异体植骨的方法进行治疗，Ⅲ级采用瘤段切除大段异体骨移植重建，术后定期随访。[结果]在128例骨巨细胞瘤患者中，儿童患者8例发病率为6．3％。其中Ⅰ级2例，Ⅱ级5例，Ⅲ级1例，伴发病理性骨折2例。6例行肿瘤刮除植骨后骨修复完善，肢体无畸形，2例病理性骨折愈合良好；1例异体骨段移植骨愈合良好，无塌陷及骨折，但患肢短缩2．5cm，无移植排斥；1例腓骨上端病变行腓骨小头切除，无功能障碍。术后随访2—9a，平均5．4a，未见肿瘤局部复发和远处肺转移。[结论]骨巨细胞瘤可以发生在儿童四肢长骨，刮除、氯化锌烧灼、双氧水浸泡和异体植骨可以达到满意效果，而瘤段切除会对儿童肢体发育产生影响。     

肱骨近端恶性肿瘤的保肢治疗

目的 探讨肱骨近端恶性肿瘤切除术后的重建方法。方法 36例肱骨近端恶性肿瘤,其中骨肉瘤 11例、软骨肉瘤 6例、皮质旁骨肉瘤及纤维肉瘤各 3例、原始神经外胚层瘤及恶性纤维组织细胞瘤各 2例、转移性骨肿瘤 5例、恶性骨巨细胞瘤 4例。骨肉瘤、原始神经外胚层瘤与恶性纤维组织细胞瘤患者均接受了新辅助化疗。肿瘤关节内切除 33例,关节外切除 3例。 21例采用异体半关节移植, 4例采用人工假体置换, 6例行游离锁骨移植, 5例行带骨膜血管蒂锁骨移植。结果 随访 6～ 118个月,平均 62.7个月。死亡 11例,局部复发 3例。按 Enneking功能评价标准, 21例采用异体半关节移植的患者,平均得分 24分; 4例人工假体置换的患者,平均得分 26分; 11例采用同侧锁骨重建肱骨近端的患者,平均得分 23分。结论 肱骨近端恶性肿瘤保肢手术的重建以人工假体置换和异体半关节移植为首选,儿童的保肢可选用同侧锁骨移植。保肢术后的功能与肩袖和肩外展肌的修复密切相关。     

复杂性骨巨细胞瘤的外科治疗初步随访分析

目的提出复杂性骨巨细胞瘤的定义并回顾分析其治疗方法和结果，为减少其术后复发提供临床依据。方法2001年4月～2005年4月共治疗22例复杂性骨巨细胞瘤患者。男11例，女11例。年龄15～60岁。肿瘤位于股骨下段10例，胫骨上段5例，股骨近端2例，肱骨近端2例，髋骨2例和桡骨远端l例。所有患者按Campanicci’s分级，Ⅱ级4例，余均为Ⅲ级。行肿瘤边缘性切除或扩大性切除加大段同种异体骨与关节移植14例，肿瘤型人工关节置换8例。结果将骨巨细胞瘤已穿破骨皮质和／或侵犯至关节软骨下，已发生病理性骨折，瘤组织活检显示肿瘤细胞具有较强的侵袭性和肿瘤已有一次或多次复发定义为复杂性骨巨细胞瘤。所有患者获随访6～48个月，平均23个月。2例患者分别于术后8个月和11个月复发，分别经截肢和放射治疗后好转，复发率为9％。人工关节置换的关节功能优于同种异体骨移植；不带关节的同种异体骨移植的关节功能优于带关节的同种异体骨移植。所有移植的同种异体骨均获得不同程度的骨愈合。结论对定义为复杂性骨巨细胞瘤患者采用上述方法进行治疗，可获得较低的肿瘤复发率和一定范围的关节功能，是临床上治疗复杂性骨巨细胞瘤可采用的一种方法。     

髂骨恶性骨肿瘤切除后骨盆环稳定性重建

目的 评价髂骨原发性恶性骨肿瘤及转移瘤切除后椎弓根钉棒固定系统联合异体骨移植或联合骨水泥（polymethylmethacrylate，PMMA）重建骨盆环稳定的方法及效果。方法 1999年7月～2004年7月，采用完全切除重建的方法治疗16例髂骨恶性骨肿瘤，男9例，女7例。年龄16～80岁。原发性骨肿瘤10例，其中软骨肉瘤4例，骨肉瘤3例，尤文氏瘤2例，恶性骨巨细胞瘤1例；根据Enneking肿瘤分期系统进行分期，ⅠA期2例，ⅡB期8例，髂骨完全切除后，均采用异体骨联合椎弓根钉棒固定系统重建骨盆环稳定。转移瘤6例，其中乳腺癌2例，肺癌1例，肾癌1例，甲状腺癌1例，前列腺癌1例，均为孤市性转移病灶；采用椎弓根钉棒固定系统或结合PMMA固定重建。术后观察重建并发症，局部肿瘤复发及植骨愈合情况，采用Enneking保肢功能评价标准进行功能评定。结果 10例髂骨原发性恶性骨肿瘤获随访5～65个月，平均35．6个月。可疑深部感染2例，内固定松动2例，异体植骨不愈合1例；植骨愈合时间4．2～8．4个月，平均5．8个月，无排异反应；肿瘤局部复发2例，肺转移3例，死亡2例；8例生存者平均功能评分24．8（82．7％），其中优4例、良3例、可1例。转移瘤患者中位生存期11．8个月（4．6～48．5个月），4例患者生存超过1年；术后无深部感染，2例内固定松动均未使用PMMA，局部出现新病灶3例，术后患者疼痛均有明显缓解，并能负重行走；1年时随访，平均功能评分21．7（72．3％），其中优2例、良2例。结论 椎弓根钉一棒固定系统联合异体骨或PMMA对髂骨原发性及转移性恶性骨肿瘤全髂骨切除后骨盆环重建可以达到稳定的目的，其并发症低，功能效果满意。     

进一步提高骨肉瘤的临床和基础研究水平

进一步提高骨肉瘤的临床和基础研究水平杨迪生骨肉瘤是恶性骨肿瘤之最常见者，在骨肿瘤领域占重要地位．近年来，我国骨肉瘤的临床和基础研究均有很大进展．临床研究的热点在保肢手术，已开展了多种重建方法，如人工骨关节置换、异体骨关节移植、肿瘤骨灭活再植以及显微外...     

四肢恶性骨肿瘤功能重建后的并发症防治

目的分析四肢恶性骨肿瘤功能重建后并发症的发生原因与防治。方法自2002年9月至2004年12月共有22例患者接受保肢治疗。年龄10～63岁，平均26.3岁。男10例，女12例。其中骨肉瘤15例，恶性骨巨细胞瘤2例，软骨肉瘤5例。15例骨肉瘤患者术前均接受了2～3次化疗。待伤口愈合后再接受5～6次化疗。肿瘤部位：胫骨近端5例，股骨远端12例，股骨近端1例，股骨中段2例，肱骨近端2例。手术方法为局部肿瘤完整切除，大段异体骨移植术、人工假体重建术和肿瘤灭活再植术。其中10例行人工假体重建术，10例行大段异体骨移植术，2例行肿瘤灭活再植术。结果随访7～27个月，3例骨肉瘤患者术后局部复发，复发时间分别为术后3个月、7个月、1年，后行截肢术。1例患者术后3个月出现肺转移，经化疗后肺部肿块消失；2例大段异体骨移植术患者术后出现排斥反应，伤口不愈伴感染，后经清创、腓肠肌肌皮瓣转移术后愈合。1例人工假体重建术后2周，伤口出现渗液，后经局部换药后愈合。结论恶性骨肿瘤采取保肢的术后并发症与适应证的选择、肿瘤对化疗的敏感性、瘤体切除的方式、功能重建选择的方法等都有密切的关系。因此，在对恶性肿瘤采取保肢手术治疗时，必须综合考虑上述因素，才能减少并发症的发生。     

复合骨移植修复骨肿瘤切除后大段骨关节缺损

目的 报道复合骨移植修复骨肿瘤切除后大段骨关节缺损的临床疗效。方法 2001年1月-2002年12月应用带监测皮岛的自体腓骨与大段同种异体深低温冷冻骨关节复合移植修复骨肿瘤切除后大段骨关节缺损10例。结果 10例均得到随访，随访时间5～24个月。移植的自体腓骨长度最长28cm，最短15cm。8例在术后3个月即有影像学骨性愈合，10例均于术后半年完全负重和邻近关节自由活动，术后超过1年的5例均已拆除内固定，术后1年均完全愈合。结论 带监测皮岛的自体腓骨与大段同种异体深低温冷冻骨关节复合移植是修复骨肿瘤切除后大段骨关节缺损的有效且可靠的方法，可用于骨肿瘤保肢术中。     

Proximal Tibia Reconstruction After Bone Tumor Resection: Are Survivorship and Outcomes of Endoprosthetic Replacement and Osteoarticular Allograft Similar?

Background

The proximal tibia is one of the most challenging anatomic sites for extremity reconstructions after bone tumor resection. Because bone tumors are rare and large case series of reconstructions of the proximal tibia are lacking, we undertook this study to compare two major reconstructive approaches at two large sarcoma centers.

Questions/purposes

The purpose of this study was to compare groups of patients treated with endoprosthetic replacement or osteoarticular allograft reconstruction for proximal tibia bone tumors in terms of (1) limb salvage reconstruction failures and risk of amputation of the limb; (2) causes of failure; and (3) functional results.

Methods

Between 1990 and 2012, two oncologic centers treated 385 patients with proximal tibial resections and reconstruction. During that time, the general indications for those types of reconstruction were proximal tibia malignant tumors or bone destruction with articular surface damage or collapse. Patients who matched the inclusion criteria (age between 15 and 60 years old, diagnosis of a primary bone tumor of the proximal tibia treated with limb salvage surgery and reconstructed with endoprosthetic replacement or osteoarticular allograft) were included for analysis (n = 149). In those groups (endoprosthetic or allograft), of the patients not known to have reached an endpoint (death, reconstructive failure, or limb loss) before 2 years, 85% (88 of 104) and 100% (45 of 45) were available for followup at a minimum of 2 years. A total of 88 patients were included in the endoprosthetic group and 45 patients in the osteoarticular allograft group. Followup was at a mean of 9.5 (SD 6.72) years (range, 2–24 years) for patients with endoprosthetic reconstructions, and 7.4 (SD 5.94) years for patients treated with allografts (range, 2–21 years). The following variables were compared: limb salvage reconstruction failure rates, risk of limb amputation, type of failures according to the Henderson et al. classification, and functional results assessed by the Musculoskeletal Tumor Society system.

Results

With the numbers available, after competitive risk analysis, the probability of failure for endoprosthetic replacement of the proximal tibia was 18% (95% confidence interval [CI], 10.75–27.46) at 5 years and 44% (95% CI, 31.67–55.62) at 10 years and for osteoarticular allograft reconstruction was 27% (95% CI, 14.73–40.16) at 5 years and 32% (95% CI, 18.65–46.18) at 10 years. There were no differences in terms of risk of failures at 5 years (p = 0.26) or 10 years (p = 0.20) between the two groups. Fifty-one of 88 patients (58%) with proximal tibia endoprostheses developed a reconstruction failure with mechanical causes being the most prevalent (32 of 51 patients [63%]). A total of 19 of 45 osteoarticular allograft reconstructions failed (42%) and nine of 19 (47%) of them were caused by early infection. Ten-year risk of amputation after failure for endoprosthetic reconstruction was 10% (95% CI, 5.13–18.12) and 11% (95% CI, 4.01–22.28) for osteoarticular allograft with no difference between the groups (p = 0.91). With the numbers available, there were no differences between the groups in terms of the mean Musculoskeletal Tumor Society score (26.58, SD 2.99, range, 19–30 versus 27.52, SD 1.91, range, 22–30; p = 0.13; 95% CI, ?2,3 to 0.32). Mean extension lag was more severe in the endoprosthetic group than the osteoarticular allograft group: 13.56° (SD 18.73; range, 0°–80°) versus 2.41° (SD 5.76; range, 0°–30°; p < 0.001; 95% CI, 5.8–16.4).

Conclusions

Reconstruction of the proximal tibia with either endoprosthetic replacement or osteoarticular allograft appears to offer similar reconstruction failures rates. The primary cause of failure for allograft was infection and for endoprosthesis was mechanical complications. We believe that the treating surgeon should have both options available for treatment of patients with malignant or aggressive tumors of the proximal tibia. (S)he might consider an allograft in a younger patient to achieve better extensor mechanism function, whereas in an older patient or one with a poorer prognosis where return to function and ambulation quickly is desired, an endoprosthesis may be advantageous.

Level of Evidence

Level III, therapeutic study.

     

Treatment of allograft nonunions with recombinant human bone morphogenetic proteins (rhBMP)

Fractures and nonunions are the main complications associated with bone allografts. Although the osteogenic role of recombinant human bone morphogenetic proteins (rhBMPs) has been demonstrated in experimental models and human tibial nonunions, the results are unknown for allograft nonunions. In this study, the efficacy of rhBMPs was evaluated in nonunions of femoral allografts. The results of six allograft nonunions in five patients who underwent resection of malignant bone tumours and allograft bone transplantation were analysed one to five years following application of rhBMPs at the nonunion site. There were two osteoarticular allografts and three intercalary allografts. Of three intercalary allografts, one demonstrated nonunion at both ends. Four patients received adjuvant chemotherapy and three had additional radiation therapy. There were two allograft fracture nonunions and four nonunions at the allograft-host junction. Two allograft fracture nonunions and one nonunion at the allograft-host junction were treated with 12 mg of rhBMP-2. The remaining three nonunions were treated with 7 mg of rhBMP-7 (Osigraft). The outcome and radiological evidence of healing were evaluated at a minimal follow-up of twelve months. There was neither healing of allograft fractures nor union of allograft-host junction. There was elongation or enlargement of the callus from the host. One patient continued to develop resorption of the allograft, which led to allograft fracture. Two patients who were treated with rhBMP-7 and corticocancellous allografts developed sterile drainage. There was no tumour recurrence with the use of rhBMPs after a mean follow-up of 39+/-25 months. rhBMP's alone were not sufficient to achieve healing in allograft nonunions and fractures following wide resection including periosteum and soft tissues.     

冷冻异体骨移植治疗肢体骨巨细胞瘤骨缺损77例临床报告

目的评价应用异体骨重建原发骨巨细胞瘤切除后骨缺损的肢体功能及并发症的发生情况。方法对1992年至2002年进行外科治疗、有完整随访资料的77例骨巨细胞瘤进行回顾分析。外科治疗依据Enneking外科分期原则,进行了肿瘤切除、异体骨重建。采用Mankin评分方法进行功能评定。结果平均随访时间35.3个月。76例患者存活,1例死亡。局部复发率14.1％,肺转移率5.1％,骨不愈合14.1％,关节不稳定9％,内固定折断、感染率及骨折均为6.4％。治疗满意率83.2％,最终保肢率98.7％。结论采用深低温保存异体骨进行骨巨细胞瘤切除后骨缺损的修复重建是一种有效方法;同时,异体骨移植也是一种有较高并发症发生率的重建方法,降低并发症可提高肢体功能;肿瘤复发是影响治疗满意率的主要影响因素,恰当的外科边界是治疗骨巨细胞瘤的关键。     

人工关节假体复合大段同种异体骨移植重建肢体功能

目的 探讨采用复合人工关节假体大段同种异体骨移植的方法治疗肢体恶性骨肿瘤的手术原理及效果。方法 骨肿瘤患者１６例,年龄１９岁－６０岁,其中骨肉瘤４例,软骨肉瘤２例,恶性骨巨细胞瘤３例,纤维肉瘤３例,其它恶性骨肿瘤４例,肢体功能重建方法包括：复合股骨近端的全髋关节置换术３例,复合股骨近端的双极人工股骨头置换术７例,复合股骨下端或胫骨上端的全膝关节置换６例,结果 本组１６例经１．５－５．０年随访,１例     

Reconstruction by bony allografts for malignant tumors of the skeleton at the end of growth

Summary Between Mai 1st, 1983 and December 1st, 1995, 57 bone tumors, mostly primitive and malignant have been referred to our department: there were 34 osteosarcomas and 15 chondrosarcomas. The primary treatment was 21 prosthesis, 11 bone allografts, 9 amputations or disarticulations, 8 Tikoff-Linberg procedures, 4 resections without reconstruction, 2 autografts reconstructions 1 spacer reconstruction and 1 Juvara technique.Among the 11 patients treated by bone allografts, there were 7 males and 4 females. The mean age was 27 years (range 12–70 years). The histological diagnosis was: osteosarcoma (6), chondrosarcoma (2), Ewing sarcoma (1), metastasis (1), recurrent giant cell tumor(1). The localisation was: femoral neck (1), femoral diaphysis (5), distal femur (2), proximal tibia (1), proximal humerus (2). The medical treatment of osteosarcomas and Ewing sarcomas included pre- and post-operative chemotherapy. The mean length of bone resection was 17.8 cm (range: 8–22 cm). Bone allografts were perforated, non irradiated, and cryopreserved at –196°C. Five allografts were intercalar femoral grafts, fixed with a Grosse and Kempf nail (2), or an AO blade plate, 2 allografts were intercalar femoro-tibial grafts (arthrodesis), with a titane nail, 2 allografts were osteo-chondral and ligamentar allografts, 1 in the distal femur (interlocking nail.) 1 in the proximal humerus (plate). 1 metaphyso-diaphyseal and tendinous allograft was the cuff of the cemented stem of a humeral prosthesis. 1 allograft was acetabular.Infectious and oncologic complications are non specific complications and occur with any reconstructive techniques. They belong to the surgery for malignant bone tumors. 3/11 patients (27%) have been reoperated for either a local recurrence, or a second malignant tumor or an infection. These major complications led to an amputation of the inferior limb in one patient (second malignant tumor) , and to an important handicape in the second patient despite a functional limb (infection). The patient with a local recurrence, was treated by a second-line chemotherapy and a second conservative surgery by an articular megaprosthesis. The present follow-up for this patient is 10 years from diagnosis, and 8 years from recurrence.Specific complications are related to the mechanical fragility of a dead bone, immunologically inert, the rehoming of which is very slow, partial and superficial. 4/11 patients (36%) were reoperated for fracture (in 2 osteo-chondral allografts), pseudarthrosis (1 tibio-femoral allograft) or pseudarthrosis and functional shrinkage (1 intercalar femoral allograft). In 3 of 4 cases, the function was restored or maintained at its previous level which was satisfactorily.Survival and disease-free survival: The mean follow-up was 62 months (range: 10–132 months). Two patients died from disease, and the third one exhibited lung metastases from an osteosarcoma.1 patient with a recurrent giant-cell tumor had no new recurrence, and 7 patients with malignant tumors were in first complete continuous remission. Of 6 osteosarcomas, the follow-up was between 7 and 11 years for 4 patients.When revised, all the 7 patients with intercalar allograft had an excellent or good functionnal result.Conclusion: We favour the reconstruction by cemented unmuffed megaprosthesis around the knee because it gives the most rapid functionnal recovery for these patients for whom the medical treatment is intensive and prolonged (osteosarcomas and Ewing sarcomas). Intercalar allograft is the unavoidable solution for some anatomical sites: its muscular surrounding is excellent at the thigh level, but it is poor between the femur and the tibia. Besides local oncologic complications, infection is the most dreadful complication. The reconstruction with an allograft exposes to the non union of the junctions, to stress fractures, to resorption which can lead to mechanical failure, and sometimes to host immune reactions against

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Reconstruction par allogreffes osseuses pour tumeurs malignes du squelette en fin de croissanceL'expérience de l'Hôpital de Hautepierre (1983–1995)