定制节段人工假体复合结构骨移植重建骨干肿瘤术后大段骨缺损的临床研究

目的 评价应用定制节段型人工假体复合大段结构骨移植重建骨干恶性肿瘤切除术后骨缺损的临床疗效。方法 回顾性分析我院骨肿瘤科2014年1月至2019年3月期间，采用定制节段型人工假体复合大段结构骨移植重建骨干恶性肿瘤切除术后骨缺损的病人共6例（股骨3例，胫骨2例，肱骨1例），其中2例采用大段冻干异体骨，4例采用自体游离腓骨结构植骨。采用美国骨肿瘤学会评分系统（Musculoskeletal Tumor Society 93, MSTS 93）评价术后功能。结果 所有病人均未发生围手术期并发症，且均获得随访，平均随访时间为23.8个月（1~61个月）。术后根据肿瘤性质继续辅助化疗等治疗，随访期内无复发，5例无瘤生存，1例死于原发乳腺癌肺转移（术后25个月），假体生存率为100%，4例术后6个月植骨愈合，术后MSTS 93评分平均为27分。结论 规范治疗和切除骨干恶性肿瘤后，采用定制节段型人工假体复合大段骨移植重建骨干骨缺损，实现即刻稳定重建，保留关节功能，中期植骨愈合后实现远期生物重建，并发症少，临床疗效满意。

Interim study report of customed segmental prostheses combined with structural bone graft to reconstruct the bone defect after resection of diaphyseal tumor

Objective To evaluate the results of the segmental prostheses combined with bone graft reconstructing the bone defect after resection of diaphyseal malignant tumor of limb. Methods A retrospective study was made on 6 patients from January 2014 to March 2019 who had undergone limb salvage by segmental endoprosthetic replacement combined with bone graft to reconstruct the long segmental bone defect after resection of diaphyseal malignant tumor of limb (3 femurs, 2 tibias and 1 humerus). Two cases were treated with large freeze-dried allogenic bone and 4 cases were treated with autologous free fibular bone graft. Postoperative function was evaluated by the Musculoskeletal Tumor Society 93 (MSTS 93). Results All patients had no perioperative complications and were followed up for an average of 23.8 months (1-61 months). According to the nature of the tumors, adjuvant chemotherapy was continuously given after operation. During the follow-up period, there was no recurrence, 5 cases survived without tumors, 1 case died of lung metastasis from primary breast cancer (25 months), the survival rate of prosthesis was 100%, 4 cases healed with bone graft 6 months after operation, and the MSTS93 score averaged 27 points after operation. Conclusion After standardized treatment and excision of malignant bone tumors, a custom-made segmental prosthesis combined with large bone graft was used to reconstruct the defect of bone, to obtain immediate and stable reconstruction, to preserve joint function, and to achieve long-term biological reconstruction after mid-term bone graft healing, with fewer complications and satisfactory clinical efficacy.