Friedrich Jeffrey B, Moran Steven L, Bishop Allen T, Wood Christina M, Shin Alexander Y
Division of Hand and Microvascular Surgery, Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA.
J Bone Joint Surg Am. 2008 Jan;90(1):93-100. doi: 10.2106/JBJS.G.00551.
Long-bone allograft reconstruction following tumor extirpation can be complicated by problems such as nonunion at the host-allograft junction, allograft fracture, or allograft infection. Free vascularized bone grafts can be used to address these complications. The purpose of the current study was to examine retrospectively the outcomes and complications following allograft reconstruction salvage with onlay vascularized fibular grafts.
A tumor registry review was conducted to identify all patients who underwent a reconstruction with a vascularized fibular graft for allograft reconstruction complications following tumor resection (host-graft nonunion, allograft fracture, or allograft nonunion) in the last nineteen years. The records of these patients were analyzed for details regarding the neoplasms and the treatment thereof, details of the free vascularized fibular graft reconstruction, time to osseous union, functional outcome, and clinical outcome.
Thirty-three patients satisfied the criteria for this study. The involved bones were the femur (eighteen patients), tibia (eight), and humerus (seven). Osseous union was achieved in all patients at a mean of 7.7 months. The average duration of follow-up was seventy-three months. Twenty-three patients achieved a good or excellent functional outcome. Ultimately, seven patients had a failure of the allograft reconstruction, which resulted in limb loss in five of them. Postoperative complications were relatively common in this series.
Free vascularized fibular grafting is a useful adjunctive surgical treatment for nonunion, fracture, and infection of an intercalary allograft reconstruction in limb salvage surgery. It has, however, a high rate of associated complications often resulting in failure.
肿瘤切除术后长骨同种异体骨重建可能会出现一些并发症，如宿主-同种异体骨结合处不愈合、同种异体骨骨折或同种异体骨感染。带血管蒂游离骨移植可用于解决这些并发症。本研究的目的是回顾性分析采用腓骨带血管蒂骨膜瓣移植挽救同种异体骨重建的疗效及并发症。
通过肿瘤登记系统回顾性分析过去19年中所有因肿瘤切除术后同种异体骨重建并发症（宿主-移植物不愈合、同种异体骨骨折或同种异体骨不愈合）而接受带血管蒂腓骨移植重建的患者。分析这些患者的肿瘤及治疗细节、带血管蒂游离腓骨移植重建细节、骨愈合时间、功能结局和临床结局。
33例患者符合本研究标准。受累骨骼为股骨（18例）、胫骨（8例）和肱骨（7例）。所有患者均实现骨愈合，平均愈合时间为7.7个月。平均随访时间为73个月。23例患者功能结局良好或优秀。最终，7例患者同种异体骨重建失败，其中5例导致肢体缺失。本系列术后并发症相对常见。
带血管蒂游离腓骨移植是肢体挽救手术中节段性同种异体骨重建不愈合、骨折和感染的一种有用的辅助手术治疗方法。然而，其相关并发症发生率较高，常导致手术失败。
