复合移植重建恶性骨肿瘤切除后骨缺损

目的将切除的肿瘤骨去除瘤组织、经灭活处理后植回原位．重建骨骼的缺损。方法1997年7月～2000年12月．对24例长骨恶性骨肿瘤患者施行了广泛切除加灭活骨移植物复合假体重建骨缺损的治疗．其中成骨肉瘤17例，骨转移癌7例。肿瘤广泛切除后．清除瘤骨上所有的肿瘤组织，开槽打通髓腔，再经200g／L高渗盐水浸泡30mm．体积分数95％的酒精浸泡20min．然后植回原位。13例采用灭活肿瘤骨结合人工关节复台重建骨缺损．11例采用灭活肿瘤骨结合交锁髓内钉重建骨干缺损。所有成骨肉瘤患者术前均行两个周期的规范化疗。结果所有患者均获随访，中位随访时问为2.5年。术后1例患者发生灭活骨与宿主骨接合处的连接失败。2例患者在术后6个月～2年内局部复发，1例接受了肿瘤再切除治疗、另1例接受了截肢手术。无一例发生灭活骨的疲劳性骨折。术后6个月时重建关节的功能评分均在25分以上。结论应用自体灭活骨代替同种异体移植物进行复合移植重建骨缺损的优点包括：(1)相对于同种异体骨，降低了骨连接部的不愈台率；(2)降低了局部感染率；（3)造价低；(4)经过平均2．5年的随访，来发现灭活骨有异体骨移植常见的骨吸收现象。体外实验证实200g/G高渗盐水对骨的渗透力较强．具有良好的灭活效果。与酒精联合应用进一步降低了局部复发率。全部病例中只有2例局部复发．占9％．达到国际上对保肢术规定的局部复发率的要求。

Limb salvage for malignant bone tumors after wide resection and reconstructed by composite prosthesis using devitalized bone grafts

Objective To anatomically reconstruct massive bone deficiency w it h prosthesis-devitalized bone composites after bone tumor resection. Methods Fr om July 1997 to December 2000, twenty-four patients with malignant bone tumor we re treated with a limb salvage procedure including wide tissue resection and rec onstruction. The resected bone were debrided of gross tumor tissues, and treated with 200 g/L saline for 30 minutes and 95% alcohol for 20 minutes, then the dev italized bone was implanted back to resection sites. Eleven diaphysis defects we re reconstructed with devitalized bone fixed with interlocked intramedullary nai ling, the other 13 defects were reconstructed with prosthesis-devitalized bone c omposites. Results The mean follow-up period was two and half years. One patient s had nonunion at the graft-host junction. There were only two patients(9%) dev eloping local recurrence in half to two years after the surgery. These indicate that this method can be accepted by the limb salvage protocol. Conclusion Prosth esis devitalized bone composite enabled surgeons to reconstruct massive bone def iciency after bone tumor resection. Compared with allografts, devitalized bone h as the following advantages: 1) This technique reduces the rate of nonunion; 2) This technique also reduces the rate of local infection; 3) This technique reduc es the cost; 4) Few absorption has been found in devitalized bone at the last fo llow up. Immersion within 200 g/L saline then after 95% alcohol provides thoroug h devitalization of tumor hosting bone.