Abed Y Y, Beltrami G, Campanacci D A, Innocenti M, Scoccianti G, Capanna R
Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
J Bone Joint Surg Br. 2009 Oct;91(10):1366-72. doi: 10.1302/0301-620X.91B10.22212.
We reviewed 25 patients who had undergone resection of a primary bone sarcoma which extended to within 5 cm of the knee with reconstruction by a combination of a free vascularised fibular graft and a massive allograft bone shell. The distal femur was affected in four patients and the proximal tibia in 21. Their mean age at the time of operation was 19.7 years (5 to 52) and the mean follow-up period 140 months (28 to 213). Three vascularised transfers failed. The mean time to union of the fibula was 5.6 months (3 to 10) and of the allograft 19.6 months (10 to 34). Full weight-bearing was allowed at a mean of 21.4 months (14 to 36). The mean functional score at final follow-up was 27.4 (18 to 30) using a modified 30-point Musculoskeletal Tumour Society rating system. The overall limb-salvage rate was 88%. The results of our study suggest that the combined use of a vascularised fibular graft and allograft is of value as a limb-salvage procedure for intercalary reconstruction after resection of bone tumours around the knee, especially in skeletally immature patients.
我们回顾了25例接受原发性骨肉瘤切除术的患者，这些肿瘤延伸至距膝关节5厘米以内，采用带血管游离腓骨移植和大块同种异体骨壳联合重建。4例患者股骨远端受累，21例患者胫骨近端受累。他们手术时的平均年龄为19.7岁（5至52岁），平均随访期为140个月（28至213个月）。3例带血管转移失败。腓骨平均愈合时间为5.6个月（3至10个月），同种异体骨为19.6个月（10至34个月）。平均在21.4个月（14至36个月）时允许完全负重。使用改良的30分肌肉骨骼肿瘤学会评分系统，最终随访时的平均功能评分为27.4（18至30）。总体保肢率为88%。我们的研究结果表明，带血管腓骨移植和同种异体骨联合使用作为膝关节周围骨肿瘤切除术后节段性重建的保肢手术具有价值，尤其是在骨骼未成熟的患者中。
