冷冻异体骨移植治疗骨肿瘤切除后骨缺损

目的探讨冷冻异体骨移植在治疗骨肿瘤切除后骨缺损中的作用。方法1992年3月至2002年9月应用深低温保存同种异体骨治疗骨肿瘤切除后骨缺损164例患者,其中男性90例,女性74例,年龄12～65岁,平均20岁。疾病种类以骨巨细胞瘤和骨肉瘤为主。外科治疗以Enneking外科分期标准为原则。主要发病部位为股骨上端、股骨下端、胫骨上端及胫骨上端及肱骨上端。异体骨均为北京骨科创伤研究所骨库提供。重建方式为1／2关节移植术95例,1／4关节移植术15例,人工关节．异体骨复合物12例,大块骨移植23例,骨干节段移植15例,骨盆骨移植4例。结果所有患者均获得随访,平均随访时间47个月。治疗满意率74．4％（122／164）,复发率12．8％（21／164）,感染率11．0％（18／164）,骨端不愈合23．2％（38／164）,内固定折断6．7％（11／164）,关节不稳定7．9％（13／164）,异体骨骨折6．7％（11／164）,死亡6．1％（10／164）,最终保肢率91．5％（150／164）。结论深低温保存异体骨降低了异体骨的免疫原性,具有与自体骨近似的骨传导性及骨诱导性,可保留韧带附丽以供软组织重建应用。但异体骨移植具有较高并发症,只有在移植骨与宿主完全愈合后,方可发挥作用。

Massive allograft replacement in management of bone tumors

OBJECTIVE: To evaluate the functional outcome and the complications of allograft replacement in management of bone tumors. METHODS: Between March 1992 and September 2002 164 patients underwent bone tumor resection and massive allograft reconstruction of bone defects. The length of the resected part ranged from 5 - 35 cm. The resections were classified as marginal or wide resections of the tumor on the basis of the Musculoskeletal Tumor Society staging system. Fresh-frozen allografts were employed as osteoarticular grafts (n = 95), hemi-condylar (n = 15), massive (n = 23), allograft-prosthesis composite (n = 12), intercalary grafts (n = 15) or hemi-pelvic grafts (n = 4). Most of the lesions were osteosarcoma and giant cell tumor of bone and located in proximal and distal femur, proximal tibia and humerus. RESULTS: At a median follow-up of 47 months (range, 12 to 168 months) after the operation, 154 of the patients in the study were free of disease and 10 died of disease. Twenty-one (12.8%) patients had local recurrence and 38 (23.2%) nonunion. Late complications included 11 (6.7%) fractures of the allograft and 18 (11.0%) infections of the graft. Instability of the joint in the form of subluxation was noted in 13 (7.9%) patients. Ten extremities were amputated due to local recurrence or severe infection. CONCLUSIONS: Allografts can be used for reconstruction of bony defects after tumor resection. Allograft has nearly similar shape, strength, osteo-inductivity and osteo-conductivity with host bone. Allograft implantation is a high complication reconstruction method, and the risk of recurrence increases when less surgical margin achieves.