Borzunov Dmitry Y, Balaev Pavel I, Subramanyam Koushik N
Department No. 4, Russian Ilizarov Scientific Centre "Restorative Traumatology and Orthopaedics", 6, Kurgan, 640014, Russia.
Department of No. 15, Russian Ilizarov Scientific Centre "Restorative Traumatology and Orthopaedics", 6, Kurgan, 640014, Russia.
Indian J Orthop. 2015 Sep-Oct;49(5):516-22. doi: 10.4103/0019-5413.164042.
The commonly used reconstructive options after post resection defects in bone tumors like megaprosthesis, autograft, allograft, bone graft substitutes and recycled bone have their own demerits on a long term. Bone transport that regenerates patient's own bone is a less explored option of reconstruction after resection of benign bone tumors and reports on this are limited. This technique is very much relevant in tibia where Ilizarov fixator is surgeon and patient friendly. We report our experience.
This is a retrospective series of resection and bone transport in 38 patients with benign tumor of tibia. There were 14 males and 24 females with mean age of 23.40 years (range 9-40 years). Lesion was located in proximal third tibia in 27, middle third in two and distal third in nine patients. The diagnosis was giant cell tumor in 32, chondroblastoma in three, chondromyxoid fibroma, enchondroma and desmoplasic fibroma in one patient each. The resection was intercalary in 28 and transarticular in 10 patients. Osteosynthesis was monofocal in three, bifocal in 31 and polyfocal in four cases.
Mean followup was 7.22 years (range 1.5-15 years). Mean resection length was 10.21 cm (range 3-22 cm). The mean duration of external fixator was 308.03 days (range 89-677 days) and mean external fixator index was 36.14 days/cm (range 16.84-97.43 days/cm). Twelve patients had difficulties in the form of 11 problems and five obstacles that were successfully managed. None of the patients had local recurrence of tumor or any long term complication. Mean Musculo-skeletal Tumour Society score at final followup was 27.18 (90.60%).
Bone transport is an excellent option after resection of benign tumors of tibia with good local control and functional outcome, despite minor difficulties that need timely management.
骨肿瘤切除术后常用的重建方法，如大假体、自体骨移植、异体骨移植、骨移植替代物和再生骨，从长期来看都有各自的缺点。骨搬运再生患者自身的骨，是良性骨肿瘤切除术后一种较少被探索的重建选择，相关报道有限。这项技术在胫骨手术中非常适用，因为伊里扎洛夫固定器对术者和患者都很友好。我们报告我们的经验。
这是一项对38例胫骨良性肿瘤患者进行切除和骨搬运的回顾性研究。其中男性14例，女性24例，平均年龄23.40岁（9 - 40岁）。27例病变位于胫骨近端三分之一处，2例位于中段三分之一处，9例位于远端三分之一处。诊断为骨巨细胞瘤32例，软骨母细胞瘤3例，软骨黏液样纤维瘤、内生软骨瘤和促结缔组织增生性纤维瘤各1例。28例患者行节段性切除，10例患者行关节周围切除。3例采用单焦点骨固定，31例采用双焦点骨固定，4例采用多焦点骨固定。
平均随访7.22年（1.5 - 15年）。平均切除长度为10.21 cm（3 - 22 cm）。外固定架平均使用时间为308.03天（89 - 677天），平均外固定架指数为36.14天/cm（16.84 - 97.43天/cm）。12例患者出现11个问题和5个障碍形式的困难，均成功处理。所有患者均未出现肿瘤局部复发或任何长期并发症。末次随访时肌肉骨骼肿瘤学会平均评分为27.18（90.60%）。
骨搬运是胫骨良性肿瘤切除术后的一种极佳选择，尽管存在一些需要及时处理的小困难，但局部控制良好，功能结果满意。
