Paholpak Permsak, Sirichativapee Winai, Wisanuyotin Taweechok, Kosuwon Weerachai, Jeeravipoolvarn Polasak
Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
Asia Pac J Clin Oncol. 2015 Jun;11(2):114-20. doi: 10.1111/ajco.12197. Epub 2014 Jun 3.
To evaluate the clinical results of primary malignant musculoskeletal tumors treated with wide resection and recycling autograft reconstruction using liquid nitrogen.
We reviewed 12 patients who had a primary malignant bone and soft tissue tumor treated by wide resection and recycling autograft reconstruction using liquid nitrogen between March 2006 and March 2013. The results were judged by recurrence, functional status and complications. Functional status was assessed according to the Musculoskeletal Tumor Society Score (MSTSS). Clinical failure was defined as need for reoperation in order to change the type of reconstruction or to amputate, and the presence of local recurrence.
The most common tumor was osteosarcoma (eight cases) followed by Ewing's sarcoma (two cases). The tibia was the most frequently involved skeletal site (six cases) followed by the femur (three cases). The median follow-up period was 32 months. In 12 patients, 7 were still alive without recurrence. There were 3 clinical failures: 1 local recurrence and 2 graft complications at 28, 51 and 20 months after reconstruction, respectively. The main complication was infection (three cases). All osteotomy sites were radiographic unions, and the union time was 8.2 ± 2.7 months. The mean ± SD MSTSS score was 79% ± 11%; excellent functional results were achieved in seven patients.
Recycling autograft reconstruction using liquid nitrogen had favorable clinical outcomes in terms of functional status and local recurrence. This reconstruction method, therefore, represents a reasonable alternative for limb salvage surgery.
评估采用液氮进行广泛切除及自体骨回植重建治疗原发性恶性肌肉骨骼肿瘤的临床效果。
我们回顾了2006年3月至2013年3月期间12例接受液氮广泛切除及自体骨回植重建治疗的原发性恶性骨与软组织肿瘤患者。通过复发情况、功能状态及并发症来判断结果。根据肌肉骨骼肿瘤学会评分（MSTSS）评估功能状态。临床失败定义为因改变重建类型或截肢而需要再次手术以及存在局部复发。
最常见的肿瘤是骨肉瘤（8例），其次是尤因肉瘤（2例）。胫骨是最常受累的骨骼部位（6例），其次是股骨（3例）。中位随访期为32个月。12例患者中，7例仍存活且无复发。有3例临床失败：分别在重建后28、51和20个月出现1例局部复发和2例移植物并发症。主要并发症是感染（3例）。所有截骨部位均实现影像学骨愈合，愈合时间为8.2±2.7个月。MSTSS评分的平均值±标准差为79%±11%；7例患者获得了优异的功能结果。
就功能状态和局部复发而言，采用液氮进行自体骨回植重建具有良好的临床效果。因此，这种重建方法是保肢手术的一种合理替代方案。
