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目的探讨大段异体骨移植治疗肢体长管状骨骨干肿瘤节段性切除后骨缺损的疗效。方法1995年7月至2006年7月应用此方法治疗骨原发良恶性肿瘤45例,资料完整者26例,胫骨13例,股骨7例,肱骨6例。按照Enneking分期,恶性肿瘤行边缘切除或广泛切除,部分行新辅助化疗。大段同种异体骨采用深低温冷冻保存,异体骨长度平均1 2.2cm,钢板螺丝钉或交锁髓内钉固定。结果随访14个月至13年,平均64.1个月。3例死亡,2例复发,2例感染。总骨端愈合率为66.7%,愈合时间平均15.7个月。截骨面位于松质骨者,愈合率为84.6%,愈合时间平均9.6个月。骨端不愈合者中,2个端为钢板螺丝钉固定(14.3%),12个端为交锁髓内钉固定(40%)。异体骨骨折1例(4.2%)。术后功能评定采用MSTS评分,上肢21~28分,平均25.6分;下肢19~27分,平均24.8分。结论大段异体骨移植与宿主骨愈合后,在内固定的支持和协同作用下,有望长期甚至终身使用。在坚强内固定的支持下,较长时间的等待会增加骨端愈合率。不愈合患者通过接触端再植骨后,仍有较高的愈合机会。
Objective To investigate the curative effect of large segment allogeneic bone graft in the treatment of segmental bone defects after long segmental bone and bone tumors of limbs. Methods From July 1995 to July 2006, 45 cases of benign and malignant primary bone tumors were treated with this method. There were 26 cases with complete data, 13 cases of tibia, 7 cases of femur and 6 cases of humerus. According to Enneking staging, resection or extensive excision of the margins of malignant tumors, some of the neoadjuvant chemotherapy. A large section of allogenic bone cryogenic cryopreservation, allogeneic bone length an average of 1 2.2cm, screw fixation or interlocking intramedullary nail. The results were followed up for 14 months to 13 years, an average of 64.1 months. 3 died, 2 recurred and 2 infected. Total bone healing rate was 66.7%, healing time averaging 15.7 months. The osteotomy surface located in cancellous bone, the healing rate was 84.6%, the healing time average 9.6 months. Among the nonunion patients, the two ends were fixed with steel screws (14.3%) and the 12 ends were fixed with interlocking intramedullary nail (40%). One case of allogeneic bone fracture (4.2%). Postoperative functional assessment by MSTS score, 21 to 28 minutes, an average of 25.6 points; lower extremity 19 to 27 points, an average of 24.8 points. Conclusion Large bone allograft and host bone healing, with the support and synergy of internal fixation, is expected to long-term or even lifelong use. With strong internal fixation, longer waiting times increase bone healing. Non-union patients still have a higher chance of healing after they have been replanted by contact.