Paris Descartes University, Cochin Hospital, Orthopaedic Surgery Department, 26, rue du faubourg Saint-Jacques, 75014 Paris, France.
Orthop Traumatol Surg Res. 2011 Sep;97(5):512-9. doi: 10.1016/j.otsr.2011.03.021. Epub 2011 Jul 13.
Performing intercalary segment reconstruction after malignant bone tumour resection results in both mechanical and biological challenges. Fixation must be solid enough to avoid short-term or mid-term mechanical failure. The use of an allograft or autograft must ensure long-term survival of the reconstruction. The goal of this study was to analyse the clinical and radiological outcomes of these reconstructions.
Thirteen patients were operated on eight femurs and five tibias. The median age was 20 years old (range 14-50). The most common diagnosis was osteosarcoma. The median resection length was 15cm (Q1-Q3: 6-26). A plate was used for fixation in nine cases and an intramedullary locked nail in four cases. An isolated bone autograft was used in two cases, an isolated bone allograft in one case, a dual autograft-allograft composite in six cases, and vascularised fibula and allograft combination in four cases.
The cumulative probability of union was 46% (95% CI: 0-99%) at 1 year; at the final follow-up, union was achieved in 12 patients (92%). Because of non-unions, 13 iterative procedures were needed to obtain these results. A non-displaced fracture of a cuboid-shaped tibial graft occurred in one patient, which was treated conservatively. Three infections occurred.
The results of intercalary segmental defects reconstruction after bone tumour resection were good, both from an oncologic and radiological point-of-view. One or more iterative procedures are sometimes needed to finally obtain bone union. We prefer to use a free rectangular cuboidal tibial graft since reconstruction with a vascularised autograft is technically more difficult. The choice of fixation methods is still controversial and no approach was found to be superior.
Level IV. Retrospective study.
在恶性骨肿瘤切除术后进行间插段重建会带来机械和生物方面的挑战。固定必须足够牢固，以避免短期或中期机械失效。同种异体或自体移植物的使用必须确保重建的长期存活。本研究的目的是分析这些重建的临床和影像学结果。
13 名患者在 8 个股骨和 5 个胫骨上进行了手术。中位年龄为 20 岁（范围 14-50 岁）。最常见的诊断是骨肉瘤。中位切除长度为 15cm（Q1-Q3：6-26）。9 例采用钢板固定，4 例采用髓内锁定钉固定。2 例采用单纯骨自体移植物，1 例采用单纯骨同种异体移植物，6 例采用双自体-同种异体复合移植物，4 例采用带血管腓骨和同种异体移植物组合。
1 年时，愈合的累积概率为 46%（95%CI：0-99%）；在最终随访时，12 名患者（92%）实现了愈合。由于不愈合，需要进行 13 次迭代手术才能达到这些结果。1 名患者发生胫骨移植 Cuboid 形无移位骨折，保守治疗。发生 3 例感染。
骨肿瘤切除后间插段缺损重建的结果在肿瘤学和影像学方面都很好。有时需要进行一次或多次迭代手术才能最终实现骨愈合。我们更喜欢使用游离矩形 Cuboid 胫骨移植物，因为血管化自体移植物重建技术上更困难。固定方法的选择仍存在争议，没有一种方法被证明是优越的。
IV 级。回顾性研究。
