Huang Junqi, Bi Wenzhi, Han Gang, Jia Jinpeng, Xu Meng, Wang Wei
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China.
Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853,
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2017 Aug 15;31(8):908-912. doi: 10.7507/1002-1892.201704044.
To analyze the effectiveness of unicompartment allografts replacement for reconstructing bone defect after bone tumor resection around knee.
Between January 2007 and January 2014, a total of 9 patients received unicompartment allografts replacement to treat bone tumor around the knee, including 6 males and 3 females, with an average age of 25.8 years (range, 17-38 years). There were 7 patients with bone giant cell tumor (postoperative recurrence of bone giant cell tumor in 1 case) and 2 patients with chondromyxoid fibroma. The tumors were located at the distal femur in 7 cases and proximal tibia in 2 cases, and the tumors were almost at the lateral limbs. The symptom duration was 2-5 months (mean, 3.2 months). The size of lesion ranged from 6 cm×2 cm to 9 cm×4 cm by X-ray film and MRI; and the metastasis was excluded by CT. The length of the allograft was 8.0-9.2 cm (mean, 8.6 cm).
The intraoperative blood loss volume was 400-550 mL (mean, 480 mL); and 0-3 U of erythrocyte was transfused after operation. The continuous exudate of incision occurred in 1 patient, and cured after 3 months; the other incisions healed primarily at 2 weeks after operation. All patients were followed up 3-10 years (mean, 6 years). No operation area infection, allograft bone poor healing or rupture was found. At 1 year after operation, the knee range of motion was 90-110° (mean, 100°); the Musculoskeletal Tumor Society score was 24-29 (mean, 26). Low density area (osteolysis) was found in 6 allografts; no articular surface collapse, hairline fracture, or fracture was found in patients; callus formation was observed in the contact surface between the allograft and the host bone, and the cortical bone showed good continuity.
Unicompartment allografts replacement can provide good support and function in terms of bone tumor resection, and achieve good effectiveness by biological reconstruction.
分析单髁同种异体骨移植置换术在重建膝关节周围骨肿瘤切除术后骨缺损中的有效性。
2007年1月至2014年1月,共有9例患者接受单髁同种异体骨移植置换术治疗膝关节周围骨肿瘤,其中男性6例,女性3例,平均年龄25.8岁(范围17 - 38岁)。骨巨细胞瘤患者7例(其中1例骨巨细胞瘤术后复发),软骨黏液样纤维瘤患者2例。肿瘤位于股骨远端7例,胫骨近端2例,且肿瘤几乎均位于外侧肢体。症状持续时间为2 - 5个月(平均3.2个月)。根据X线片和MRI,病变大小范围为6 cm×2 cm至9 cm×4 cm;CT排除转移。同种异体骨长度为8.0 - 9.2 cm(平均8.6 cm)。
术中失血量为400 - 550 mL(平均480 mL);术后输注红细胞0 - 3 U。1例患者切口持续渗液,3个月后治愈;其他切口术后2周一期愈合。所有患者均随访3 - 10年(平均6年)。未发现手术区域感染、同种异体骨愈合不良或破裂。术后1年,膝关节活动范围为90 - 110°(平均100°);肌肉骨骼肿瘤学会评分24 - 29分(平均26分)。6例同种异体骨出现低密度区(骨质溶解);患者未出现关节面塌陷、细微骨折或骨折;在同种异体骨与宿主骨接触面上观察到骨痂形成,皮质骨连续性良好。
单髁同种异体骨移植置换术在骨肿瘤切除方面能提供良好支撑和功能,通过生物学重建取得良好效果。