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目的探讨应用大段异体骨重建骨肿瘤切除后骨干缺损的疗效及并发症。方法回顾分析我院1998年12月至2015年12月期间使用大段异体骨重建骨干缺损的患者67例,其中股骨干32例,胫骨干23例,肱骨干12例。重建所用的异体骨为深低温冷藏,平均长度为16.5(8~30)cm,使用钢板螺丝钉、髓内针或髓内针加短钢板复合固定。随访12~182个月,平均50.2个月,观察异体骨愈合情况及并发症。结果随访结束时,5例死亡,发生严重并发症而取出异体骨7例,异体骨的5年生存率为86%。大段异体骨的骨端总愈合率为68.8%,愈合时间为6~48个月,平均16.8个月,异体骨与宿主骨接触端位于干骺端者愈合率为86.2%,接触端位于皮质者愈合率为63.6%,二者差异有统计学意义。不愈合的患者中有9例接受再次手术,均取得愈合。随访结束时MSTS评分为17~30分,平均24.3分,其中上肢患者MSTS评分为18~28分,平均24.1分,下肢患者MSTS评分为17~30分,平均24.4分。结论使用大段异体骨对骨肿瘤切除骨干缺损进行重建并完成骨愈合后,患者可长期使用,从而获得良好的功能,接触端不愈合的患者通过再次手术干预仍能达到满意的愈合率。
Objective To investigate the efficacy and complications of the application of large bone allograft in the reconstruction of bone defects after bone tumor resection. Methods A retrospective analysis of our hospital from December 1998 to December 2015 using a large section of allogeneic bone reconstruction in 67 patients with defects, of which 32 cases of femoral shaft, tibial shaft in 23 cases, 12 cases of humeral shaft. The allogeneic bone used for reconstruction was deep cryogenic refrigeration, with an average length of 16.5 (8-30) cm, which was fixed by using plate screw, intramedullary nail or intramedullary nail with short steel plate. All the patients were followed up for 12 to 182 months, with an average of 50.2 months. Allogeneic bone healing and complications were observed. Results At the end of follow-up, 5 patients died of serious complications and 7 cases of allogeneic bone were removed. The 5-year survival rate of allogeneic bone was 86%. The total bone union rate of large bone allograft was 68.8%. The healing time ranged from 6 to 48 months (mean 16.8 months). The healing rate of metaphyseal bone between the allogeneic bone and the host bone was 86.2% The healing rate was 63.6%, the difference was statistically significant. Nine patients who did not heal received reoperation and achieved healing. At the end of follow-up, the MSTS score was 17-30, with an average of 24.3 points. MSTS score was 18-28 in upper limb patients, with an average of 24.1 points and lower limbs MSTS score was 17-30 points with an average of 24.4 points. Conclusions The use of large segments of allogeneic bone to reconstruct bone defects after bone tumor resection and complete bone healing results in long-term use of the patient for good function. Satisfactory healing rates can be achieved with reoperation in patients with nonunion.