大段同种异体骨移植术在胫骨中段骨肉瘤保肢中的应用

背景：胫骨中段骨肉瘤患者的保肢手术并发症多，其保肢手术方案是当前临床治疗中的难点之一。目的：回顾性分析接受大段同种异体骨移植治疗的胫骨中段骨肉瘤病例，评估其综合临床疗效。方法：7例胫骨中段骨肉瘤患者，完成同种异体骨移植前正规辅助化疗方案，并移植前确认无远处转移。7例患者均接受大段同种异体骨移植＋内固定术治疗，异体骨平均长度12.5 cm，移植中全部行腓肠肌肌瓣转移覆盖移植骨。移植后5例患者完成化疗方案，2例部分完成化疗方案。结果与结论：随访时间18-36个月。移植后1年局部复发1例，行截肢术后出现肺转移死亡；移植后1.5年肺转移1例，转移灶切除后存活；移植后2年死于肺转移1例；余4例无瘤生存。MSTS评分：平均26.5分。ISOLS评分：平均31分。4例未成年患者中，1例患者出现双下肢不等长畸形，患肢缩短2 cm。无移植后感染病例和移植后病理性骨折病例。结果提示，严格把握适应证的前提下，使用大段同种异体骨移植治疗胫骨中段骨肉瘤能够获得较好的移植后功能；移植中行腓肠肌肌瓣转移覆盖移植骨是降低移植后并发症的有效措施。

Reconstruction with massive allograft bone for osteosarcoma of the middle tibia with limb salvage

BACKGROUND：There are many complications of limb salvage surgery in patients with osteosarcoma of the middle tibia, and the limb salvage surgery is one of the current difficulties in clinical treatment. OBJECTIVE：To evaluate the clinical efficacy of reconstruction with massive al ograft bone for osteosarcoma of the middle tibia by retrospectively reviewing relevant cases. METHODS：Seven patients with osteosarcoma of the middle tibia were treated. And we analyzed their clinical data retrospectively. Al patients completed the formal preoperative adjuvant chemotherapy and we confirmed that there was no distant metastasis before surgery. Al patients received large al ogeneic bone transplantation and internal fixation, and the gastrocnemius muscle flap coveraged graft bone in surgery. The average length of al ogeneic bone was 12.5 cm. Five patients received postoperative adjuvant chemotherapy completely, and two patients received partly. RESULTS AND CONCLUSION：The fol ow-up period was 18-36 months. One patient had local tumor recurrence at 1 year after transplantation, and died of lung metastases after amputation. One patient survived after resection of lung metastases that occurred at 1.5 years after transplantation. One patient died of lung metastases at 2 years after transplantation. The rest four patients were tumor-free. The mean Musculoskeletal Tumor Society （MSTS） score was 26.5, the mean International Society of Limb Salvage （ISOLS） graft score was 31. Among four underage patients, one had leg length deformities, with limb shortening 2 cm. There were no postoperative infections and pathological fractures. Using large al ogeneic bone for the repair of bone defects after tumor surgery of the middle tibia can have a good clinical efficacy under the premise of strict indications. Using gastrocnemius muscle flap to cover the bone graft during surgery is an effective measure to reduce postoperative complications.