Deijkers R L M, Bloem R M, Kroon H M, Van Lent J B, Brand R, Taminiau A H M
Department of Orthopaedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Clin Orthop Relat Res. 2005 Oct;439:151-60. doi: 10.1097/00003086-200510000-00029.
Epidiaphyseal intercalary reconstruction has become possible for bone tumors that extend into the epiphysis because advances in magnetic resonance imaging and chemotherapy allow close resection while sparing the juxtaarticular bone and joint. In a retrospective study, we questioned whether epidiaphyseal reconstructions around the knee had a clinical outcome (measured as long-term survival, complication rate, and functional score) comparable with metadiaphyseal and diaphyseal reconstructions. Between 1988 and 1999, 14 epidiaphyseal, nine metaphyseal, and 12 diaphyseal reconstructions were done, and the median followup was 7.2 years. Kaplan-Meier analysis showed a 10-year survival rate of 79% for epidiaphyseal reconstructions, which did not differ from an 89% rate for metadiaphyseal and a 75% rate for diaphyseal reconstructions. Epidiaphyseal complications included two infections, five fractures, and three nonunion treatments. Complications for all 35 grafts included three infections, 12 fractures, and nine nonunion treatments. Ultimately, six grafts failed, with infection and length of resection as predisposing factors. All epiphyseal osteotomies had tumor-free margins and no local recurrences. The mean Musculoskeletal Tumor Society score for each type of intercalary reconstruction was between 23 and 24. Because the epidiaphyseal reconstruction avoids complications associated with joint reconstruction and the results are comparable with those of other types of intercalary grafts, these reconstructions should be considered if at least 1 cm of tumor-free juxtaarticular bone can be maintained.
由于磁共振成像和化疗技术的进步，使得在保留关节周围骨骼和关节的同时能够进行精确切除，因此对于延伸至骨骺的骨肿瘤，骨骺间置重建已成为可能。在一项回顾性研究中，我们探讨了膝关节周围的骨骺干重建在临床结果（以长期生存率、并发症发生率和功能评分衡量）方面是否与干骺端和骨干重建相当。1988年至1999年间，共进行了骨骺重建14例、干骺端重建9例和骨干重建12例，中位随访时间为7.2年。Kaplan-Meier分析显示，骨骺重建的10年生存率为79%，与干骺端重建的89%和骨干重建的75%无差异。骨骺重建的并发症包括2例感染、5例骨折和3例骨不连治疗。所有35例移植的并发症包括3例感染、12例骨折和9例骨不连治疗。最终，6例移植失败，感染和切除长度为诱发因素。所有骨骺截骨均有肿瘤阴性切缘且无局部复发。每种间置重建的肌肉骨骼肿瘤学会平均评分为23至24分。由于骨骺重建避免了与关节重建相关的并发症，且结果与其他类型的间置移植相当，因此如果能保留至少1 cm的无肿瘤关节周围骨骼，则应考虑进行这些重建。
