Sugiura Hideshi, Takahashi Mitsuru, Nakanishi Keisuke, Nishida Yoshihiro, Kamei Yuzuru
Department of Orthopaedic Surgery, Aichi Cancer Center, 1-1 Kanokoden, Chikusa-ku, Nagoya 464-8681, Japan.
Clin Orthop Relat Res. 2007 Mar;456:196-202. doi: 10.1097/01.blo.0000246565.03833.73.
The optimal reconstruction procedure after wide resection of bone tumors is debatable. We reviewed pasteurized intercalary autogenous bone graft combined with a vascularized fibula graft in 15 patients with malignant bone tumors, and assessed whether this procedure would improve bone union and function. The mean duration until bone union of the pasteurized autogenous bone was 13.5 months and duration until union of the vascularized fibula was 7.7 months. Complete bone union between the pasteurized autogenous bone and the vascularized fibula eventually was achieved in 13 patients (86.7%). In the remaining two patients, fibula union was achieved but union of the pasteurized autogenous bone was not attributable to infection. Postoperative complications included two fractures and two infections. Three patients with delayed union eventually achieved bone union using an autogenous cancellous bone graft. The mean Musculoskeletal Tumor Society score was 80.6% and it was comparable to scores from other procedures. Our results suggest a pasteurized autogenous bone graft combined with a vascularized fibula graft can be a useful reconstruction method in selected patients with large bone defects after wide resection of malignant bone tumors.
骨肿瘤广泛切除术后的最佳重建方法存在争议。我们回顾了15例恶性骨肿瘤患者采用经巴氏消毒的自体骨中间植入物联合带血管腓骨移植的情况，并评估该方法是否能促进骨愈合及改善功能。经巴氏消毒的自体骨达到骨愈合的平均时间为13.5个月，带血管腓骨达到骨愈合的平均时间为7.7个月。最终，13例患者（86.7%）实现了经巴氏消毒的自体骨与带血管腓骨之间的完全骨愈合。在其余2例患者中，腓骨实现了愈合，但经巴氏消毒的自体骨未愈合，原因是感染。术后并发症包括2例骨折和2例感染。3例骨愈合延迟的患者最终采用自体松质骨移植实现了骨愈合。肌肉骨骼肿瘤学会的平均评分为80.6%，与其他手术方法的评分相当。我们的结果表明，经巴氏消毒的自体骨移植联合带血管腓骨移植对于恶性骨肿瘤广泛切除术后有大骨缺损的特定患者可能是一种有用的重建方法。
