深低温冷冻同种异体骨修复骨缺损的临床应用

采用—80℃深低温冷冻同种异体骨植骨治疗缺损32例。四肢良性肿瘤17例,恶性肿瘤2例,创伤性骨缺损6例,重建椎体6例,重建跟骨1例,异体骨加自体骨移植18例,单纯异体骨14例,大块异体骨移植14例。本组除1例感染失败,1例异体骨与宿主骨皮质端不愈合外其余30例切口Ⅰ期愈合,无排斥反应。X线片显示移植骨与宿主骨愈合良好,认为深低温冷冻同种异体骨是一种较理想的骨缺损修复材料。     

深低温冷冻同种异体骨修复骨缺损的临床应用

采用－８０℃深低温冷冻同种异体骨植骨治疗缺损３２例。四肢良性肿瘤１７例，恶性肿瘤２例，创伤性骨缺损６例，重建椎体６例，重建跟重１例，异体骨加自体骨移植１８例，单纯异体骨１４例，大块异体骨移植１４例。Ｘ线片显示移植骨与宿主骨愈合良好，认为深低温冷冻同种异体骨是一种较理想的骨缺损修复材料。     

髂骨供骨后骨缺损的重建及供区并发症的预防

目的:探讨通过同种异体髂骨重建自体髂骨供骨后骨缺损预防供区并发症的治疗方法及效果。方法:采用同种异体髂骨修补自体髂骨供骨后骨缺损20例,男9例,女11例;年龄19~56岁,平均34岁;共用22块髂骨;同种异体髂骨块为全厚或半厚,大小6 cm×5 cm、5 cm×4 cm、4 cm×3 cm 3种规格;其中19块采用空心钉固定,2块采用空心钉结合克氏针固定,1块单独采用克氏针固定。结果:20例患者均获随访,随访时间8~20个月,平均13.5个月。19例切口Ⅰ期愈合,1例发生皮肤浅表感染,经换药Ⅱ期愈合。所有患者手术后供骨区髂部外形保持完整,未发生植骨块移位、植入物松动、断裂、免疫排斥反应等并发症。术后6个月复查未发现供骨区慢性疼痛、系腰带痛及行走痛。所有患者对髂部外形表示满意。结论:同种异体髂骨可有效重建自体髂骨供骨后骨缺损,预防髂骨供区并发症。     

冷冻保存带血管异体骨移植治疗儿童骨缺损

目的：报道采用冷冻保存带血管同种异体骨移植修复儿童骨缺损的治疗结果。方法：自１９９２～１９９５年对２０例儿童大块骨缺损采用吻合血管的冷冻保存同种异体骨移植进行修复。年龄３～１３岁，平均７．９岁，骨缺损长度６．０～１２．０ｃｍ。供骨取自患儿父、母或同胞子女，术后４周应用免疫抑制剂。随访２～５年，平均３年７个月。结果：术后３个月异体骨与宿主骨全部骨性愈合，４～６个月患肢功能恢复正常，无不良反应。结论：对治疗儿童大块骨缺损，应用吻合血管的冷冻保存同种异体骨移植术是一种有效的方法，可取得类似于吻合血管的自体骨移植的治疗效果     

自固化磷酸钙复合BMP及同种异体骨修复兔股骨大段骨缺损

[目的] 观察一种新型自固化磷酸钙（CPC）复合BMP与同种异体骨修复兔股骨节段性骨缺损的效果，为临床复合应用大段同种异体骨移植提供参考。[方法] 54只新西兰大白兔随机分成3组，于一侧股骨中上段造成2cm长皮质骨缺损模型，分别进行：A组复合BMP与CPC的新鲜冷冻同种异体骨移植；B组单纯新鲜冷冻同种异体骨移植；C组自体大段骨移植。移植骨均用直径3mm三棱髓内针固定。于术后4、8、12周，进行影像学、组织学检查，对比各组移植骨愈合过程与修复效果。[结果] CPC复合BMP大段同种异体骨移植早期骨修复效果优于单纯异体骨移植（P〈0．01），与自体骨移植修复效果相似，至12周3组均达骨性愈合，以A组及C组骨修复塑形较好。CPC复合BMP组骨痂量较多，分布于移植骨与宿主骨结合部及移植骨周围，形成皮质骨外骨桥，并较早在异体骨外表面形成破骨与成骨，异体骨内哈佛氏管扩大，衬垫细胞、成骨细胞、破骨细胞及血细胞较其它组多。CPC随着新骨的形成及改建塑形逐步缓慢降解。[结论] CPC复合BMP对大段同种异体骨移植的愈合及替代有增强和促进作用。     

人工骨联合自体骨髓移植技术的骨缺损修复研究与应用

目的分析人工骨联合自体骨髓移植技术治疗骨缺损的临床疗效。方法选取2011年4月至2013年9月,来本院诊治的四肢粉碎性骨折术后骨缺损患者40例,随机分为两组（A、B组）,分别行自体髂骨植骨和人工骨联合自体骨髓移植治疗四肢粉碎性骨折所致骨缺损。术后观察两组骨折愈合时间,骨折愈合率,并发症的发生及骨缺损的修复和功能重建优良率。结果两组均行6～12个月随访,平均（9.14±1.36）月,所有患者植骨术后均无切口感染、发热等并发症。A组15例骨缺损区愈合良好,住院时间平均（19.36±2.54）天,骨折愈合时间平均（5.67±1.52）个月,骨缺损的修复和功能重建评价标准,优12例,良3例,可3例,差2例,优良率75%;B组18例骨缺损区愈合良好,住院时间平均（12.19±1.52）天,骨折愈合时间平均（3.61±1.13）个月,骨缺损的修复和功能重建评价标准,优16例,良2例,可2例,差0例,优良率90%。B组骨缺损治疗效果显著优于A组。结论人工骨联合自体骨髓移植较单纯自体髂骨移植治疗骨缺损更能促进骨痂生长,加速骨折后骨缺损愈合,更加有效地减少住院时间及骨折愈合时间,骨折愈合率更高,骨缺损修复和功能重建效果更加显著。     

同种异体骨移植的研究进展

同种异体骨移植是目前临床广泛使用于治疗各种骨缺损和促进脊柱融合的方法。根据处理方式的不同,同种异体骨可以分为：新鲜异体骨、深冻骨、冷冻干燥骨（fresh frozen allograft, FFA）和脱钙骨基质（demineralized bone matrix, DBM）。同种异体骨与新鲜的自体骨的愈合机制有着本质不同,其主要依靠“爬行替代”实现与宿主骨的融合,因此愈合速度慢、愈合质量差,容易发生骨不连和移植骨骨折,故存在较高的失败率。而复合生长因子、复合间充质干细胞以及红骨髓等方法可以提高异体骨愈合的速度。利用组织工程的原理与方法,采用复合移植的方法使异体骨得到活化,是今后异体骨移植研究与应用的发展方向。     

长段同种异体骨与自体带血管组织组合治疗大段骨缺损的总结

目的 通过研究血管化及促进骨愈合的方法,解决大段异体骨移植骨吸收、骨不连及再骨折等并发症.方法 对四肢10 cm以上长段骨缺损21例,采用钢板、外固定架等常规方法将大段异体骨与自体骨固定,同时采用异体骨与自体血管束、带血供骨或骨膜组合的方法,使异体骨血管化,达到促进骨愈合、防止异体骨溶解、吸收等并发症作用.其中4例采用局部血管束植入一侧断端;4例采用带血管髂骨块嵌入长段骨中部;2例带血管髂骨植入一侧骨断端;2例带血管腓骨嵌入中部;6例带血管骨膜植入一侧断端;另外血管束或骨膜加骨块组合植入3例.结果 21例中经一次治疗骨性愈合14例,经二次手术痊愈6例,失败1例.出现骨吸收、不愈合及再骨折等并发症7例,合并感染4例.经随访功能、外观满意.结论 采用自体带血管骨(膜)与同种异体骨组合移植治疗长段骨缺损,可改善大段异体骨移植的骨吸收、骨不连等并发症,有利于骨折的早期愈合.为治疗长段骨缺损较为理想的方法.     

同种异体骨植骨治疗四肢骨折临床疗效研究

目的 总结同种异体骨植骨治疗四肢骨折的疗效,探讨手术适应证及优缺点.方法 分别采用自体髂骨及同种异体骨植骨治疗四肢骨折500例,对两种植骨方法 术后患者恢复情况进行分析比较.结果 两种方法 在术后Palev评分、骨折愈合时间上无明显差异,术后并发症发生率有明显差异(P＜0.05).结论 同种异体骨治疗四肢骨折效果明确,但需要重视术后并发症,排斥反应尚需进一步研究.     

复合骨移植在下肢骨肿瘤保肢治疗中的应用

目的探讨复合骨移植在下肢骨肿瘤保肢术中重建骨缺损的手术原理及效果。方法应用携带监测皮岛吻合血管的自体腓骨与深低温冷冻大段同种异体骨复合移植，重建下肢骨肿瘤切除后的长段骨缺损12例。其中，骨肉瘤6例，恶性纤维组织细胞瘤1例，骨纤维结构不良2例，骨巨细胞瘤3例。结果12例经术后8～38个月随访，1例死于肺转移，2例带瘤存活，9例无瘤存活。术后功能优良率达75％。10例术后3个月内X线示骨端骨性愈合，2例内固定失败重新外固定后骨性愈合，所有均在9个月内能完全负重行走。结论携带监测皮岛吻合血管的自体腓骨与深低温冷冻大段同种异体骨复合移植，适用于下肢骨肿瘤保肢术中的长段骨缺损的修复，具有自体活骨移植和异体骨移植的双重优点。     

硫酸钙人工骨填充良性骨肿瘤刮除后骨缺损愈合情况的临床研究

目的分析硫酸钙人工骨填充良性骨肿瘤刮除后骨缺损的愈合情况,探讨人工骨在骨肿瘤切除重建中的作用。方法自2005年12月至2008年3月,应用Osteo Set硫酸钙人工骨移植治疗72例原发良性骨肿瘤,其中随访资料完整的47例。根据术后随访期X线片所见评估人工骨降解、吸收和骨愈合生长情况,评估38例含脱钙骨基质（demineralized bone matrix,DBM）和9例未含DBM硫酸钙人工骨的愈合情况,研究植骨量对愈合情况的影响,同时采用肌肉骨骼肿瘤协会（Musculoskeletal Tumor Society,MSTS）功能评分评价关节功能。结果 47例患者获3～55个月随访,平均随访时间16.3个月。均有人工骨颗粒与宿主骨间隙变模糊以及颗粒间变模糊,平均用时3.1（1～6）个月;42例完全吸收,用时4.2（1～12）个月;27例重新塑形,用时7.3（3～17）个月。人工骨愈合良好39例（83.0%）,未出现不愈合病例。含DBM硫酸钙与不含DBM硫酸钙人工骨植入患者的愈合率分别为89.5%和77.8%。植骨量≤5mL组愈合率95.6%,用时6.8（3～12）个月;植骨量〉5mL组愈合率79.2%,用时5.5（3～17）个月。对两组愈合率、愈合时间进行比较,差异无统计学意义（Z=-0.100,P=0.920;Z=-0.650,P=0.516）。MSTS功能评分平均28.8分。术后2例出现伤口不愈合。结论对于良性骨肿瘤切除后骨缺损的重建,硫酸钙人工骨愈合效果满意,是一种安全、有效的移植材料。     

The effect of osteogenic protein-1 on the healing of segmental bone defects treated with autograft or allograft bone.

BACKGROUND: Large amounts of bone graft are frequently used to elicit the healing of bone defects resulting from reconstructive procedures. Autograft and allograft bone are often used, but each has its limitations. Bone morphogenetic proteins (BMPs) improve the healing of segmental bone defects treated with autograft or allograft. The objective of the present study was to determine the effect of implantation of a recombinant osteogenic protein-1 (OP-1) in combination with bone graft on the healing of a critical-sized (2.5-cm) segmental defect in canine ulnae. METHODS: Either autograft bone, allograft bone, osteogenic protein-1 (OP-1) mixed with type-1 bovine collagen, or various combinations of OP-1 and collagen (OP-1 device) mixed with allograft or autograft were implanted in the segmental bone defects. The combinations included 67% bone graft with 33% OP-1 device and 33% bone graft with 67% OP-1 device. The healing of the defects was assessed with radiographic, biomechanical, and histological studies. The animals were killed at twelve weeks postoperatively. RESULTS: The use of the OP-1 device alone or any combination of autograft or allograft bone and the OP-1 device demonstrated improved healing on radiographic, mechanical, and histological studies compared with that demonstrated after use of autograft or allograft bone alone. The highest radiographic and histological grades and the greatest mechanical strength were achieved with the use of 33% allograft and 67% OP-1 device, although no significant differences were observed among the different groups containing the OP-1 device. At twelve weeks postoperatively, the defects treated with any amount of the OP-1 device obtained greater mechanical strength than that obtained by autograft bone alone. CONCLUSIONS: Major bone defects may be treated with allograft bone combined with the OP-1 device, instead of autograft alone, to avoid complications associated with the use of autograft. The combination of allograft bone and the OP-1 device resulted in optimum healing of the defect, according to the radiographic, mechanical, and histological parameters measured in this study. CLINICAL RELEVANCE: The combination of freeze-dried allograft bone with the OP-1 device is an attractive graft material for the treatment of large bone defects. Although similar results were observed when autogenous bone graft was used in combination with the OP-1 device, the results of the present study suggest that allograft, because of its relatively unlimited supply, can be substituted without reduced efficacy. In addition, avoiding the need to harvest autogenous bone eliminates the additional operative time and risk associated with a second surgical procedure.     

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。     

3种动力髋螺钉固定方式治疗骨质疏松性股骨粗隆间骨折的比较研究

目的比较单纯动力髋螺钉(DHS)内固定、骨水泥强化联合DHS内固定以及异体人工骨主钉道植骨配合DHS内固定3种术式治疗老年性骨质疏松股骨粗隆间骨折的疗效差别。方法采用随机数字表法将2010年1月至2012年9月广州医科大学附属第二医院收治、符合病例选择标准的90例老年骨质疏松性股骨粗隆间患者随机分入单纯DHS内固定组(对照组)、骨水泥强化联合DHS内固定组(骨水泥组)和异体人工骨主钉道植骨配合DHS内固定组(植骨组),每组30例。比较3组术后Harris髋关节功能评分优良率、骨折愈合时间及术后并发症发生率的差异。结果 90例患者均获完整随访,随访时间12~18个月(平均14.8个月)。植骨组、骨水泥组和对照组术后Harris功能评分优良率分别为93%、80%、70%,植骨组明显优于对照组(P0.05);与对照组、骨水泥组比较,植骨组骨折愈合时间明显缩短(P0.05);3组中植骨组并发症发生率最低(3%),远低于对照组和骨水泥组(27%和10%)。结论异体人工骨主钉道植骨配合DHS内固定治疗老年性骨质疏松股骨粗隆间骨折具有髋关节功能恢复好、骨折临床愈合时间短、并发症少等优点,临床效果满意。     

自体与异体肌腱微创重建踝关节外侧韧带的临床对比研究

 目的 比较应用自体半腱肌腱与同种异体肌腱微创移植重建踝关节外侧韧带的临床疗效。方法 回顾性分析2006年9月至2011年6月采用微创手术治疗慢性踝关节外侧不稳患者资料。其中应用自体半腱肌腱重建踝关节外侧韧带（自体组）32例,男19例,女13例;年龄17～62岁,平均32.4岁。同期应用同种异体肌腱重建踝关节外侧韧带（异体组）36例,男22例,女14例;年龄15～67岁,平均34.2岁。两组患者均采用相同的手术方法重建距腓前韧带及跟腓韧带。结果 自体组手术时间[（85.5±11.5） min］长于异体组[（58.1±10.2）min］,发热天数异体组[（5.5±1.5）d］长于自体组[（2.5±1.2）d］。自体组23例随访（33.5±6.7）个月,异体组26例随访（28.5±6.7）个月。美国足踝外科协会（AOFAS）踝与后足评分,自体组术前（62.3±8.2）分,术后（95.1±7.5）分;异体组术前（60.2±8.4）分,术后（94.8±5.5）分。5例患者（自体组3例、异体组2例）在不平地面行走时,踝关节有残余不稳定。自体组1例患者平整地面行走踝关节有残余不稳定。自体组无一例膝部肌腱供区功能障碍。术后AOFAS评分自体组16例为优,5例为良,2例为差;异体组17例为优,5例为良,4例为差。应力位X线片示自体组距骨倾斜角平均由14.0°减少到3.8°,异体组平均由13.0°减少到3.6°;距骨前移距离自体组平均由12.3 mm减少到4.6 mm,异体组平均由11.5 mm减少到4.3 mm。结论 自体肌腱与同种异体肌腱移植重建踝关节外侧韧带的临床疗效无差异,但自体肌腱愈合时间较异体肌腱快,而异体肌腱具有损伤小,手术简便等优点。     

颗粒性植骨在高龄骨质疏松股骨粗隆间骨折动力髋关节螺钉内固定术中的应用

目的探讨颗粒性植骨在动力髋关节螺钉（DHS）内固定治疗高龄骨质疏松股骨粗隆间骨折患者中的应用效果。方法对56例EvansⅢ～Ⅳ型高龄骨质疏松股骨粗隆间骨折患者采用DHS治疗,其中采用同种异体颗粒骨植骨26例,非植骨组30例。术后对两组患者进行至少半年以上随访,分析手术时间、术中出血量、骨折愈合时间、末次随访时髋关节功能Harris评分及并发症进行比较。结果所有患者获得6～22个月（平均14个月）的随访,两组手术时间、术中失血量等临床指标比较差异均无统计学意义（P〉0.05）,但两组骨折愈合时间之间有统计学差异（t=2.441,P〈0.05）。术后Harris评分植骨组26例中优15例,良9例,可2例,差0例,优良率92.3%;不植骨组30例中优10例,良15例,可3例,差2例,优良率83.3%,两组之间无统计学差异（x~2=1.026,P〉0.05）。并发症情况,植骨组有髋内翻1例,无钢板、螺钉切割拔出、螺钉断裂;不植骨组髋内翻4例,术后螺钉切割拔出1例,钢板、螺钉断裂2例。结论 DHS内固定治疗EvansⅢ～Ⅳ型高龄骨质疏松股骨粗隆间骨折患者时,通过粗隆间骨缺损区颗粒性植骨,提高骨折的早期愈合强度,维持内固定的稳定性,是减少该类患者术后螺钉松动、切割移位、内同定失效、骨折不愈合或畸形愈合的有效方法之一,其手术操作方法简单,临床疗效满意,值得进一步探讨。     

骨髓基质细胞移植修复半月板无血运区损伤的实验研究

目的比较自体与同种异体骨髓基质细胞移植对半月板无血运区损伤修复的影响。方法 40只成年新西兰大白兔随机平均分为 A、 B两组。 A组兔的骨髓基质细胞 (MSC)经体外培养后与纤维蛋白凝胶 (FG)混合,自体移植于其一侧的膝关节半月板缺损区,即 FG＋自体 MSC（自体移植组）;另一侧单纯植入 FG(FG植入组 )。于 B组兔的一侧膝关节半月板缺损区移植 FG＋同种异体 MSC(异体移植组 ),另一侧缺损不予修复 (空白对照组 )。分别于术后第 1、 2、 3个月取材,观察半月板损伤部位的组织形态学变化。结果 (1)自体移植组 :术后 1个月缺损区可见纤维组织,内有大量成纤维细胞;术后 2个月见大量软骨细胞并有胶原纤维形成;术后 3个月损伤区呈纤维软骨愈合。 (2)空白对照组 :术后 1～ 3个月缺损区始终未愈合。 (3)单纯 FG植入组 :术后 1～ 3个月缺损区可见纤维组织,内有少量成纤维细胞,没有软骨细胞生长,呈瘢痕样愈合。 (4)同种异体移植组 :与自体移植组所见大致相同,但有 3侧缺损区可见大量淋巴细胞浸润,胶原纤维少。结论骨髓基质细胞移植可促进半月板无血运区损伤的愈合,同种异体骨髓基质细胞移植修复半月板无血运区损伤发生免疫排斥反应的机率较低。     

Evaluation of bone incorporation of patellar tendon autografts and allografts for ACL reconstruction using CT

Anterior cruciate ligament (ACL) reconstruction is a relatively common orthopedic procedure, with patellar tendon frequently a graft source. However, controversy exists regarding the decision to use autograft or allograft patellar tendon tissue. This experimental study used computed tomography (CT) to compare the percentage of bone graft incorporation following ACL reconstruction using autografts and allografts. Fifty consecutive patients undergoing ACL reconstruction were included in the study. The tibial bone plug was imaged with CT 1 week, 2 months, and 5 months postoperatively. Four images from each completed scan were analyzed for percentage of incorporation of the bone graft. The results of autograft and allograft incorporation for each of the time intervals were compared. No statistically significant difference was found in the amount of bone incorporation at the tibial bone plug 1 week, 2 months, and 5 months. Clinical concerns regarding slower or less complete healing of allograft bone tissue compared to autograft are not supported with regard to the grafts studied.     

自体与γ射线照射和非照射异体骨-髌腱-骨重建前十字韧带的比较研究

目的 比较自体与γ射线照射和非照射异体骨-髌腱-骨(bone patellar tendon bone,B-PT-B)重建膝关节前十字韧带(anterior cruciate ligament,ACL)的临床疗效.方法 107例ACL断裂患者随机分为三组:36例采用自体B-PT-B(自体组),36例采用深低温冷冻保存异体B-PT-B(异体组),35例采用γ射线照射深低温冷冻保存异体B-PT-B(γ射线组).由同一术者采用标准关节镜技术完成ACL重建.结果 自体组(36例)平均随访39.5个月、异体组(34例)36.3个月、γ射线组(33例)37.6个月.(1)自体组术中髌骨骨折1例、术后膝前痛2例,异体组出现迟发感染1例.自体组手术时间较异体组、γ射线组长,术后发热天数较异体组、γ射线组短.(2)自体组、异体组轴移试验、Lachman试验或前抽屉试验及KT-2000检测结果 的差异无统计学意义,与γ射线组比较差异均有统计学意义.γ射线组ACL重建失败率(36%)高于自体组(8%)、异体组(9%).三组Daniel单腿水平跳跃试验、IKDC评分及Lysholm-Tegner运动水平评分的差异无统计学意义.结论 深低温冷冻异体与自体B-PT-B重建ACL短期疗效接近.经γ射线照射后异体B-PT-B重建ACL的膝关节前后及旋转稳定性均降低.     

Intercalary reconstruction following resection of diaphyseal bone tumors: A systematic review

IntroductionThe options for the reconstruction of diaphyseal defects following the resection of bone tumors include biological or prosthetic implants. The purpose of our study was to evaluate different types of intercalary reconstruction techniques, including massive bone allograft, extracorporeal devitalized autograft, vascularized free fibula, and modular prosthesis.MethodsWe performed a systematic review of articles using the terms diaphyseal bone tumor and intercalary reconstruction. All the studies reporting the non-oncological complications such as infection, nonunion and fracture of the intercalary reconstructions were included. We excluded articles published before 2000 or did not involve humans in the study. Case reports, reviews, technique notes and opinion articles were also excluded based on the abstracts. Thirty-three articles included in this review were then studied to evaluate failure rates, complications and functional outcome of different surgical intercalary reconstruction techniques.ResultsNonunion rates of allograft ranged 6%–43%, while aseptic loosening rates of modular prosthesis ranged 0%–33%. Nonunion rates of allograft alone and allograft with a vascularized fibula graft ranged 6%–43% and 0%–33%, respectively. Fracture rates of allograft alone and allograft with a vascularized fibula graft ranged 7%–45% and 0%–44%, respectively. Infection rates of allograft alone and allograft with a vascularized fibula graft ranged 0%–28% and 0%–17%, respectively. All of the allograft (range: 67%–92%), extracorporeal devitalized autograft including irradiation (87%), autoclaving (70%), pasteurization (88%), low-heat (90%) or freezing with liquid nitrogen (90%), and modular prosthesis (range: 77%–93%) had similar Musculoskeletal Tumor Society functional scores. Addition of a vascularized fibula graft to allograft did not affect functional outcome [allograft with a vascularized fibula graft (range: 86%–94%) vs. allograft alone (range: 67%–92%)].ConclusionAseptic loosening rates of modular prosthesis seem to be less than nonunion rates of allograft. Adding a vascularized fibula graft to allograft seems to increase bone union rate and reduce the risk of fractures and infections, though a vascularized fibula graft needs longer surgical time and has the disadvantage of donor site morbidity. These various intercalary reconstruction techniques with or without a vascularized fibula autograft had similar functional outcome.