大块同种异体骨移植重建骨肿瘤巨大骨缺损78例

回顾性分析1999-08/2007-01解放军广州军区广州总医院骨科收治的骨肿瘤切除后骨缺损患者78例，男47例，女31例，年龄7~56岁，平均21.5岁。其中骨巨细胞瘤34例，骨肉瘤12例，动脉瘤样骨囊肿11例，平滑肌肉瘤2例，腺泡状软组织细胞瘤1例，骨纤维结构不良18例。以Enneking外科分期标准为原则，对肿瘤进行切除。主要发病部为股骨上端，股骨干，股骨下端，胫骨上端，骨盆。重建方式以行大块骨移植63例，骨干移植10例，髂骨移植2例，人工关节-异体骨复合物移植3例。全部患者均获得随访，平均37.9个月。移植后结果以Mankin等所提出的评定标准为原则优36例，良29例，中4例，差9例。出现局部排斥反应18例，予反复抽吸积液及抗排斥反应治疗7~54 d后症状消失，肿瘤复发7例，感染4例，骨不连5例，异体骨骨折1例，关节不稳定2例。大块异体骨与宿主骨在移植后1周就可在接合部出现明显的骨痂生成，在接合部和异体骨表面尽量布满细小的异体骨或自体骨可明显加强骨诱导。提示采用大块异体骨重建骨肿瘤术后大的缺损，临床效果良好，取得满意效果。 关键词：骨肿瘤；同种异体骨；移植

Reconstruction of bone defects with massive bone allograft for bone tumor treatment in 78 cases

Objective To investigate the feasibility of massive bone allografts to repair a huge bone defect in the management of bone tumor . Method 78 cases of patients, 47 cases of men and women in 31 cases, underwent bone tumor resection and massive allograft reconstruction of bone defects. The average age of 21.5 years old (7 to 56 years old).Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, femur, proximal tibia and pelvic. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh frozenallografts were employed as massive(53), long bone(10), iliac bone(2), allograft prosthesis composite(2). Result The average follow-up of 37.9 months. 36 cases of excellent, good in 29 cases, fair in 4 cases, 9 cases of poor. Local rejection of 18 cases, 4 cases of infection, 5 cases of nonunion , 7 cases of recurrence, 2 cases of joint instability. Conclusion The large bone reconstruction of large bone defects after tumor resection achieved satisfactory results.