Liu Tang, Guo Xiaoning, Zhang Xiangsheng, Li Zhihong, Zhang Qing
Department of Orthopaedics, the 2nd Xiangya hospital, Central South University, Changsha, Hunan, P.R. China.
Bull Cancer. 2012 Sep;99(9):87-91. doi: 10.1684/bdc.2012.1626.
The aim of this study was to assess the specific protocol for the treatment of primary malignant bone tumors of distal tibiae in a group of patients for limb salvage, with wide "en bloc" intra-articular excision and reconstruction of the defect with recycled pasteurized autograft, which was stabilized using an internal fixator.
Between 1994 and 2009, ten patients (three females and seven males) at a mean age of 26.5 years old were treated for malignant bone tumors of the distal tibiae with "en bloc" intra-articular excision and ankle arthrodesis using recycled pasteurized autograft. Nine cases were histopathologically diagnosed as high-grade osteosarcoma, and one case as invasive osteoblastoma. All bone tumors were staged according to Enneking's criteria with two stages IIA cases, and eight stages IIB cases.
At a mean follow-up of 81 months, the mean postoperative functional score was 74.3%. All the patients had bony union at the last follow-up. Six patients required secondary iliac crest cancellous bone grafting at the proximal end to achieve union. The mean time for graft union was 18.9 months, and the average union time of the proximal junctions was longer than that of the distal junctions. Superficial infection occurred in two patients (20.0%), which were resolved by changing dress. There was no deep infection or graft fracture during the entire procedure.
The use of pasteurized bone graft for primary malignant bone tumors of distal tibia indicated a satisfactory outcome, with regard to graft survival, complications, and functional results. A pasteurized auto-graft can be an easily accessible and economical alternative of high efficiency for the usual reconstruction modalities.
本研究旨在评估一组采用肢体挽救治疗方案的患者中，针对胫骨远端原发性恶性骨肿瘤的具体治疗方案，该方案包括广泛的“整块”关节内切除，并使用经回收巴氏消毒的自体移植物重建缺损，并用内固定器进行稳定固定。
1994年至2009年间，对10例平均年龄26.5岁的患者（3例女性和7例男性）采用“整块”关节内切除和踝关节融合术治疗胫骨远端恶性骨肿瘤，并使用经回收巴氏消毒的自体移植物。9例经组织病理学诊断为高级别骨肉瘤，1例为侵袭性骨母细胞瘤。所有骨肿瘤均根据Enneking标准分期，其中2例为IIA期，8例为IIB期。
平均随访81个月时，术后平均功能评分为74.3%。所有患者在最后一次随访时均实现了骨愈合。6例患者需要在近端进行二次髂骨松质骨移植以实现愈合。移植骨愈合的平均时间为18.9个月，近端结合处的平均愈合时间长于远端结合处。2例患者（20.0%）发生浅表感染，通过更换敷料得以解决。整个过程中未发生深部感染或移植骨骨折。
对于胫骨远端原发性恶性骨肿瘤，使用巴氏消毒骨移植在移植物存活、并发症和功能结果方面显示出令人满意的结果。巴氏消毒自体移植物对于常规重建方式而言，是一种易于获取且经济高效的替代方案。
