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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,B期5例,B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。
Objective To investigate the feasibility of allogeneic bone graft and artificial prosthesis replacement for the repair of long segmental bone defects after resection of bone tumor. Methods From August 1999 to December 2003, 28 long-term allografts of bone were resected and reconstructed in the bone defect after resection of extremity malignant tumors. Including 16 cases of osteosarcoma, paraneoplastic osteosarcoma in 4 cases, 5 cases of Ewing’s sarcoma, soft tissue sarcoma bone invasion in 3 cases. Preoperative biopsy and postoperative pathological examination were confirmed, Enneking staging, B in 5 cases, B in 23 cases. All patients with osteosarcoma and Ewing’s sarcoma received standardized preoperative and postoperative chemotherapy. Eighteen cases were reconstructed with allogeneic bone prosthesis. Ten cases were treated with long bone allograft transplantation and interlocking intramedullary nailing. Postoperative MSTS score for functional evaluation. Results All patients were followed up for 5 ~ 48 months with an average of 24 months. One case had local recurrence six months after operation, amputation was performed, nonunion and severe bone resorption occurred in 3 cases, and 2 cases were deep infection. No postoperative bone fracture occurred. Among them, 23 cases recovered well after operation, with a MSTS score of 15-27, an average of 23.4. Conclusion Allogeneic bone transplantation combined with artificial joint replacement is an effective method to reconstruct bone defects after resection of malignant tumor of extremities. Stable internal fixation, to ensure stable contact with the host bone allograft, helps to reduce the incidence of complications.