胫骨近端骨-关节同种异体移植物在肿瘤保肢手术中的应用。
Proximal tibia osteoarticular allografts in tumor limb salvage surgery.
机构信息
Institute of Orthopedics Carlos E Ottolenghi, Italian Hospital of Buenos Aires, Potosí 4215, 1199 Buenos Aires, Argentina.
出版信息
Clin Orthop Relat Res. 2010 May;468(5):1396-404. doi: 10.1007/s11999-009-1186-y. Epub 2009 Dec 18.
BACKGROUND
Resection of large tumors of the proximal tibia may be reconstructed with endoprostheses or allografts with fixation. Endoprosthetic replacement is associated with high failure rates and complications. Proximal tibia osteoarticular allografts after tumor resection allows restoration of bone stock and reconstruction of the extensor mechanism, but the long-term failure rates and complications are not known.
QUESTIONS/PURPOSES: We therefore determined (1) the middle- and long-term survival of proximal tibia osteoarticular allografts, (2) their complications, and (3) functional (Musculoskeletal Tumor Society score) and radiographic (International Society of Limb Salvage) outcomes in patients treated with this reconstruction.
PATIENTS AND METHODS
We retrospectively reviewed 52 patients (58 reconstructions including six repeat reconstructions) who underwent osteoarticular proximal tibia allograft reconstructions after resection of a bone tumor. The minimum followup of the 46 surviving patients was 72 months (mean, 123 months; range, 10-250 months). Survival of the allograft was estimated using the Kaplan-Meier method. We documented outcomes using the Musculoskeletal Tumor Society functional scoring system and the International Society of Limb Salvage radiographic scoring system.
RESULTS
Six patients died from tumor-related causes without allograft failure before the 5-year radiographic followup. At last followup, 32 of the 52 remaining allografts were still in place; 20 failed owing to infections, local recurrences, or fractures. Overall allograft survival was 65% at 5 and 10 years, with an average Musculoskeletal Tumor Society functional score of 26 points and an average radiographic result of 87%.
CONCLUSIONS
Based on these data we believe proximal tibia osteoarticular allograft is a valuable reconstructive procedure for large defects after resection of bone tumors.
LEVEL OF EVIDENCE
Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
背景
切除胫骨近端的大肿瘤后，可以用假体或同种异体骨进行重建，并用固定物固定。假体置换与高失败率和并发症相关。肿瘤切除后的胫骨近段关节同种异体骨移植可恢复骨库存并重建伸肌机制，但长期失败率和并发症尚不清楚。
问题/目的：因此，我们确定了（1）胫骨近段关节同种异体骨移植的中、长期存活率，（2）其并发症，以及（3）采用这种重建方法治疗的患者的功能（肌肉骨骼肿瘤学会评分）和影像学（国际保肢协会）结果。
患者和方法
我们回顾性分析了 52 例（58 例重建，包括 6 例重复重建）患者，这些患者在切除骨肿瘤后接受了胫骨近段关节同种异体骨重建。46 例存活患者的最短随访时间为 72 个月（平均 123 个月；范围，10-250 个月）。采用 Kaplan-Meier 法估计同种异体移植物的存活率。我们使用肌肉骨骼肿瘤学会功能评分系统和国际保肢协会影像学评分系统记录结果。
结果
在 5 年影像学随访前，有 6 例患者因肿瘤相关原因死亡，且同种异体骨未发生失败。在最后一次随访时，52 例患者中仍有 32 例同种异体骨存在；20 例因感染、局部复发或骨折而失败。5 年和 10 年时，同种异体骨总存活率分别为 65%，平均肌肉骨骼肿瘤学会功能评分为 26 分，平均影像学结果为 87%。
结论
根据这些数据，我们认为胫骨近段关节同种异体骨是骨肿瘤切除后大缺损的一种有价值的重建方法。
证据水平
IV 级，治疗研究。欲了解完整的证据水平描述，请参见作者指南。
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