Farfalli Germán L, Aponte-Tinao Luis, Lopez-Millán Lucas, Ayerza Miguel A, Muscolo D Luis
Carlos E. Ottolenghi Institute of Orthopedics, Italian Hospital of Buenos Aires, Potosí 4247 (1199), Buenos Aires, Argentina. german.
Orthopedics. 2012 Mar 7;35(3):e391-6. doi: 10.3928/01477447-20120222-25.
Reconstruction after intercalary resection of the tibia is demanding due to subcutaneous location, poor vascularity of the tibia, and high infection rate. The purpose of this study was to evaluate the survivorship, complications, and functional outcome of intercalary tibial allograft reconstructions following tumor resections. Intercalary tibia segmental allografts were implanted in 26 consecutive patients after segmental resections. Patients were followed for an average of 6 years. Allograft survival was determined with the Kaplan-Meier method. Patient function was evaluated with the Musculoskeletal Tumor Society (MSTS) scoring system. Survivorship was 84% (95% confidence interval [CI], 98%-70%) at 5 years and 79% (95% CI, 63%-95%) at 10 years. Allografts were removed in 5 patients due to 3 infections and 2 local recurrences. Two patients showed diaphyseal nonunion, and 3 patients underwent an incomplete fracture; no allografts were removed in these patients. Average MSTS functional score was 29 points (range, 27-30 points). Despite the incidence of complications, this analysis showed an acceptable survivor-ship with excellent functional scores. The use of intercalary allograft has a place in the reconstruction of a segmental defect created by the resection of a tumor in the diaphyseal or metaphyseal portion of the tibia.
由于胫骨位于皮下、血运较差且感染率高，胫骨节段性切除后的重建颇具挑战性。本研究的目的是评估肿瘤切除术后胫骨节段性同种异体骨重建的存活率、并发症及功能结果。在26例连续患者行节段性切除后植入胫骨节段性同种异体骨。患者平均随访6年。采用Kaplan-Meier法确定同种异体骨存活率。采用肌肉骨骼肿瘤学会（MSTS）评分系统评估患者功能。5年时存活率为84%（95%置信区间[CI]，98%-70%），10年时为79%（95%CI，63%-95%）。5例患者因3例感染和2例局部复发而取出同种异体骨。2例患者出现骨干骨不连，3例患者发生不完全骨折；这些患者未取出同种异体骨。MSTS功能评分平均为29分（范围27-30分）。尽管有并发症发生，但该分析显示存活率可接受且功能评分优异。胫骨节段性同种异体骨在重建胫骨骨干或干骺端肿瘤切除后造成的节段性缺损方面有其应用价值。
