Virolainen Petri, Inoue Nozomu, Nagao Masato, Frassica Frank J, Chao Edmund Y S
Department of Orthopaedic Surgery, Orthopaedic Biomechanics Laboratory, Johns Hopkins University, The Ross Research Building, 720 Rutland Avenue, Room 235 Baltimore, MD 21205-2196, USA.
J Orthop Res. 2005 Jul;23(4):795-801. doi: 10.1016/j.orthres.2005.01.006. Epub 2005 Mar 2.
Use of combination adjuvant chemotherapies have improved the disease free survival rate of tumor patients significantly. However, studies have shown that chemotherapeutic agents have negative effects on bone graft incorporation and fixation of porous-coated prostheses needed for reconstruction of bone defects after wide resection of malignant tumors. Unilateral resection of a 6-cm segment of the femoral diaphysis and reconstruction with a porous-coated segmental prosthesis was performed in eight mixed-breed dogs under perioperative chemotherapy with doxorubicin, cisplatin, and ifosfamide. Eight strips of autogenous cortical bone were evenly placed around the junctions between the femur and the prosthetic surface. Autogenous cancellous bone was placed under and between the strips of cortical bone. Two cycles of the chemotherapy were given preoperatively, and three cycles postoperatively. The animals were followed for 12 weeks, with sequential assessments of weight-bearing and radiographic evaluation. Biomechanical, histological, and microradiographic analyses of the retrieved specimens were performed. Doxorubicin, cisplatin, and ifosfamide combination chemotherapy showed a significant effect on new bone formation as seen in reduced callus size and lower ultimate strength of extracortical fixation. However, the onlay corticocancellous grafting method provided better biologic fixation of the prosthesis compared with fixation without any bone grafting under non-chemotherapy condition in a previous study. Extracortical bone grafting is an effective modality for implant fixation even under intensive chemotherapy.
联合辅助化疗的应用显著提高了肿瘤患者的无病生存率。然而，研究表明，化疗药物对骨移植的融合以及恶性肿瘤广泛切除后骨缺损重建所需的多孔涂层假体的固定具有负面影响。在围手术期使用阿霉素、顺铂和异环磷酰胺进行化疗的情况下，对8只杂种犬进行了6厘米股骨干中段的单侧切除，并使用多孔涂层节段性假体进行重建。将8条自体皮质骨条均匀放置在股骨与假体表面的连接处周围。自体松质骨放置在皮质骨条下方和之间。术前给予两个周期的化疗，术后给予三个周期的化疗。对动物进行12周的随访，依次进行负重评估和影像学评估。对取出的标本进行生物力学、组织学和显微放射学分析。阿霉素、顺铂和异环磷酰胺联合化疗对新骨形成有显著影响，表现为骨痂尺寸减小和皮质外固定的极限强度降低。然而，与先前研究中在非化疗条件下不进行任何骨移植的固定相比，贴附式皮质松质骨移植方法为假体提供了更好的生物固定。即使在强化化疗的情况下，皮质外骨移植也是植入物固定的有效方式。
