异体骨移植重建四肢肿瘤切除后的骨缺损

目的探讨同种异体骨移植及联合人工假体置换修复骨肿瘤切除后长段骨缺损的可行性。方法1999年8月～2003年12月对28例四肢恶性肿瘤切除后的骨缺损进行了长段同种异体骨段移植重建。其中骨肉瘤16例，骨旁骨肉瘤4例，尤文肉瘤5例，软组织肉瘤骨侵犯3例。均经术前活检及术后病理检查确诊，Enneking分期，IB期5例，ⅡB期23例。所有骨肉瘤及尤文肉瘤患者均接受规范术前及术后化疗。18例采用异体骨人工关节复合物重建，10例采用长段异体骨干移植，带锁髓内钉内固定。术后采用MSTS评分进行功能评价。结果所有患者获随访5～48个月，平均24个月。1例术后半年出现局部复发，行截肢术；3例出现异体骨与宿主骨接合处的不愈合和严重的骨吸收；2例深部感染。术后未发生移植骨骨折。其中23例术后功能恢复良好，MSTS评分15～27分，平均23．4分。结论异体骨移植及联合人工关节置换是重建四肢恶性肿瘤切除后骨缺损的一种有效方法。行坚强内固定，保证异体骨与宿主骨稳定接触，有助于减少并发症的发生。

SEGMENTAL ALLOGRAFT RECONSTRUCTION IN SKELETAL DEFECT AFTER LIMB TUMOR RESECTION

OBJECTIVE: To study the clinical feasibility of the prosthetic composites of the intercalary allograft and the segmental allograft in reconstruction of the skeletal defect after the limb tumor resection. METHODS: Between August 1999 and December 2003, 28 patients with skeletal defects after the limb tumor resection were treated with the intercalary allograft or the segmental allograft megaprosthesis composite for reconstruction of skeletal defects. The bone involvements were observed in 16 patients with osteosarcoma, 4 patients with parosteal osteosarcoma, 5 patients with Ewing sarcoma, and 3 patients with soft tissue sarcoma. Preoperative biopsy was performed on all the patients, and the pathological result was confirmed after surgery. According to the Enneking system, 5 patients were grouped in I B and 23 patients in I B. The patients with osteosarcoma or Ewing sarcoma received the standard chemotherapy before and after operation. Eighteen and ten patients received the segmental allograft prosthetic composite replacement and the intercalary allograft with the interlocking intramedullary nail fixation, respectively. The functional outcome was evaluated by the MSTS score. RESULTS: According to the follow-up for 5-48 months (average, 24 months), local recurrence was observed in 1 patient who underwent amputation eventually. Of the 28 patients, 3 developed nonunion of the allograft-host junction accompanied by severe resorption and 2 developed deep infection. No allograft fracture was seen in the patients. Most of the patients achieved a good functional result with an average MSTS score of 23. 4. CONCLUSION: The prosthetic composite replacement of the intercalary allograft and the segamental allograft can be used in the skeletal defect reconstruction after the limb tumor resection. The stable contact in the allograft-host junction and the strong intramedullary internal fixation can help to reduce the complication rate of the allograft.