Avedian R S, Goldsby R E, Kramer M J, O'Donnell R J
UCSF Comprehensive Cancer Center, Orthopaedic Oncology Service, San Francisco, CA 94115-1939, USA.
Clin Orthop Relat Res. 2007 Jun;459:48-53. doi: 10.1097/BLO.0b013e3180514c66.
Chemotherapy has long been suspected of having an adverse effect on bone healing. Massive tumor endoprostheses which achieve osseointegration via compressive force provide a unique model to study the effects of chemotherapy on bone healing. We compared distal femoral bone hypertrophy in patients who received chemotherapy with those who did not. Fifty four patients underwent distal femoral reconstruction with a compression implant. Thirty patients received chemotherapy (Group 1), and 24 did not (Group 2). The group of patients receiving chemotherapy was younger, had lower body mass indices, and had different diagnoses compared to the group of patients not receiving chemotherapy. We used a standardized technique to measure bone growth at the bone-prosthetic interface. The rate of cortical width increase at the bone-prosthetic junction was faster in Group 2 compared to Group 1. Similarly, the increase in cortical width from immediate postop to 3 months and 6 months postop was greater in Group 2 when compared to Group 1. The data suggest chemotherapy administration for musculoskeletal malignancy has a substantial initial adverse effect on bone hypertrophy and a trend towards reduced prosthetic survival. These findings have important implications for the patients with musculoskeletal tumors.
长期以来，人们一直怀疑化疗会对骨愈合产生不良影响。通过压力实现骨整合的大型肿瘤假体为研究化疗对骨愈合的影响提供了一个独特的模型。我们比较了接受化疗的患者与未接受化疗的患者的股骨远端骨肥大情况。54例患者接受了股骨远端加压植入重建术。30例患者接受了化疗（第1组），24例未接受化疗（第2组）。与未接受化疗的患者组相比，接受化疗的患者组更年轻，体重指数更低，诊断也不同。我们使用标准化技术测量骨-假体界面处的骨生长。与第1组相比，第2组在骨-假体交界处的皮质宽度增加率更快。同样，与第1组相比，第2组在术后即刻至术后3个月和6个月时皮质宽度的增加更大。数据表明，对肌肉骨骼恶性肿瘤进行化疗对骨肥大有显著的初始不良影响，并有降低假体生存率的趋势。这些发现对肌肉骨骼肿瘤患者具有重要意义。
