长骨肿瘤切除后节段性骨缺损的一期骨关节重建

作者采用瘤段骨切除１．灭活再植，自家或同种异体腓骨髓内移植，或加松质骨髓内移植，梯形或Ｌ－梯形钢板（ＴＣＰ或Ｌ－ＴＣＰ）固定；２．保留骨骺或关节骨壳，自家或同种异体节段皮质骨，或加松质骨移植，ＴＣＰ或Ｌ－ＴＣＰ固定；３．同种异体骨及全髁膝关节假体置换，自家腓骨及髂骨髓内移植，ＴＣＰ固定；４．全桡骨切除，自家腓骨移植。治疗骨肉瘤１８例，巨细胞瘤１０例，侵袭大或复发的骨纤维异样增殖症１９例２１个骨。共４７例４９个骨，５０次手术。骨缺损长度７．８～２３．５ｃｍ，平均１４．４ｃｍ。随访１８个月～８年４个月者４３例４５个骨，４６次手术。术后感染４例５次（８．５％）；２例并发骨不连及应力骨折而失败，其中１例截肢。其余再植骨及移植骨均与宿主骨一次手术愈合（９５．６％）。骨不连和疲劳骨折的发生率分别为４．３％（２例）及６．５％（３例）。作者强调从生物学和机械力学两方面考虑，对节段性骨缺损采用一期骨关节重建的术式治疗，有利骨愈合和恢复功能，减少复发和骨不连，疲劳骨折等并发症。

One Stage Reconstruction of Bone and Joint in Treatment of Segmental Defect Following Tumor Resection in Long Bone

From June 1986, 47 patients with 49 segmental defect (7.8 to 23.5 cm) of long bones after tumor resection were treated. The lesions included osteosarcoma in 18, giant cell tumor in 10 and aggressive fibrous dysplasia in 19. Following procedures were performed with segmental fibular graft (SFG) and fixed with trapezoid compression plate(TCP or L-TPC). 1.Resection of tumor bone and replantated after cuettage and soaking in alcohol for 30 munites; 2.Resection of tumor bone but leaving the epiphysis of articular intact and replaced with autogenous or allogenous segmental cortical bone graft; 3.Resection of tumor bone and allogenous bone graft alone or with total condylar prosthesis replacement of the knee and 4. Radical resection of tumor bone and replaced with autogenous SFG. Forty-three patients were followed up for 18 months to 8 years and 4 months. Deep infection occurred in 4 cases (8.5%). Two of them were cured by irrigation and skin flag transfer, and the other 2 were failed. Bone defect was repaired and had sound union in 40 patients with 42 bones (95.4%).Two developed stress fracture and nonunion due to deep infection. Amputation was performed in one.The incidence of nonunion and stress fracture was 4.3% and 6.5% respectively. The authors considered that the procedures methods above was beneficial for bone healing and functional recovery and the intramedullary fibular graft, as an osteogenesis inductor, was an ideal resorbable internal fixation material.