节段性异体骨移植重建治疗下肢骨肿瘤的长期临床疗效。

Long-Term Clinical Outcomes of Intercalary Allograft Reconstruction for Lower-Extremity Bone Tumors.

机构信息

Departments of Orthopaedic Surgery (P.T.J.S., J.F.S., M.P.A.B., M.A.J.v.d.S., and P.D.S.D.) and Medical Statistics and Biomedical Sciences (M.F.), Leiden University Medical Center, Leiden, the Netherlands.

Carlos E. Ottolenghi Institute of Orthopaedics, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.

出版信息

J Bone Joint Surg Am. 2020 Jun 17;102(12):1042-1049. doi: 10.2106/JBJS.18.00893.

DOI:10.2106/JBJS.18.00893

PMID:32265356

Abstract

BACKGROUND

Improved survival rates for patients with primary bone tumors of the extremities have increased the demand for reliable and durable reconstruction techniques. Some authors have stated that, after successful ingrowth, allografts are a durable long-term solution. This hypothesis is largely based on small studies with short-to-midterm follow-up. In order to determine the durability of intercalary allograft reconstructions in the lower extremities, we evaluated the long-term clinical outcomes at a minimum of 10 years.

METHODS

All patients who received an intercalary allograft reconstruction in a lower extremity between 1980 and 2006 were included in this retrospective multicenter cohort study. One hundred and thirty-one patients with a median age of 19 years were included. Eighty-nine (68%) had a femoral reconstruction, and 42 (32%) had a tibial reconstruction. The most prevalent diagnoses were osteosarcoma (55%), Ewing sarcoma (17%), and chondrosarcoma (12%). The median follow-up was 14 years. A competing risk model was employed to estimate the cumulative incidences of mechanical failure and infection. Patient mortality or progression of the disease was used as a competing event.

RESULTS

Nonunion occurred in 21 reconstructions (16%), after a median of 16 months, and was associated with intramedullary nail-only fixation (p < 0.01) and fixation with nonbridging plate(s) (p = 0.03). Allograft fracture occurred in 25 reconstructions (19%) after a median of 42 months (range, 4 days to 21.9 years). Thirteen (52%) of the allograft fractures occurred within 5 years; 8 (32%), between 5 and 10 years; and 4 (16%), at >10 years. With failure for mechanical reasons as the end point, the cumulative incidences of reconstruction failure at 5, 10, and 15 years were 9%, 14%, and 21%, respectively.

CONCLUSIONS

Intercalary allograft reconstruction is an acceptable reconstructive option, mainly because of the absence of superior alternatives with a known track record. However, a considerable and continuing risk of mechanical complications should be taken into account.

LEVEL OF EVIDENCE

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

摘要

背景

原发性四肢骨肿瘤患者的生存率提高，增加了对可靠和耐用重建技术的需求。一些作者指出，在成功植入后，同种异体移植物是一种持久的长期解决方案。这一假设主要基于短期至中期随访的小型研究。为了确定下肢间插异体骨重建的耐久性，我们在至少 10 年的时间里评估了长期的临床结果。

方法

本回顾性多中心队列研究纳入了 1980 年至 2006 年间接受下肢间插异体骨重建的所有患者。共纳入 131 例患者，中位年龄为 19 岁。89 例（68%）行股骨重建，42 例（32%）行胫骨重建。最常见的诊断为骨肉瘤（55%）、尤文肉瘤（17%）和软骨肉瘤（12%）。中位随访时间为 14 年。采用竞争风险模型估计机械故障和感染的累积发生率。患者死亡或疾病进展被用作竞争事件。

结果

21 例（16%）重建发生了骨不连，中位时间为 16 个月，与髓内钉固定（p < 0.01）和非桥接钢板固定（p = 0.03）有关。25 例（19%）重建发生了异体骨骨折，中位时间为 42 个月（范围为 4 天至 21.9 年）。13 例（52%）的异体骨骨折发生在 5 年内；8 例（32%）发生在 5 至 10 年内；4 例（16%）发生在 10 年以上。以机械原因导致的失败为终点，5、10 和 15 年时重建失败的累积发生率分别为 9%、14%和 21%。