Division of Plastic Surgery, Department of Surgery, University of Pennsylvania, Philadelphia, PA.
Northwestern Feinberg School of Medicine, Chicago, IL.
J Plast Reconstr Aesthet Surg. 2020 Jul;73(7):1221-1231. doi: 10.1016/j.bjps.2020.02.030. Epub 2020 Feb 18.
Limb salvage surgery has become a first-line treatment in the setting of lower extremity cancer. Despite a multitude of techniques, the most effective modality for osseous reconstruction has not been described. We aim to examine outcomes of allograft reconstruction alone compared to an allograft combined with a vascularized fibula graft (VFG) (Capanna Technique) through a meta-analysis of the literature.
A systematic review of the literature was conducted through the online databases PubMed, Embase, and Web of Science, examining articles utilizing an allograft with or without an intramedullary VFG for the reconstruction of lower extremity osseous defects following oncological resection. A meta-analysis examined outcomes, including nonunion, infection, fractures, explantation, and functional limb status, that were evaluated dependent upon reconstructive modality.
Twenty-five articles were deemed appropriate for inclusion. The allograft with VFG group had considerably lower rates of nonunion (13%) in comparison to the allograft alone group (21.4%) (p < .001). Rates of infection (7.9% vs. 9%, respectively) and fracture (19.6% vs. 19.1%) were not statistically different. The allograft with VFG group also had significantly lower rates of explantation (6.57%) compared to the allograft alone cohort (18.11%) (p < .001). Functional outcomes were similar across groups as measured by Musculoskeletal Tumor Society scores (88.22% vs. 87.77%).
Allograft reconstruction with a supplementary inlay VFG decreases the risk of nonunion and explantation compared to allograft alone reconstruction in the setting of oncological resection of the osseous lower extremity. This technique warrants increased consideration in the operative planning of lower limb reconstruction following tumor extirpation.
在下肢癌症的治疗中，保肢手术已成为一线治疗方法。尽管有多种技术，但尚未描述最有效的骨重建方法。我们旨在通过对文献的荟萃分析，检查单独使用同种异体骨重建与同种异体骨联合带血管腓骨移植（Capanna 技术）重建的结果。
通过在线数据库 PubMed、Embase 和 Web of Science 对文献进行系统回顾，检查使用同种异体骨或带或不带髓内 VFG 重建肿瘤切除后下肢骨缺损的文章。荟萃分析检查了结果，包括非融合、感染、骨折、假体取出和功能肢体状况，这些结果根据重建方式进行评估。
有 25 篇文章被认为适合纳入。带 VFG 的同种异体骨组的非融合率（13%）明显低于单独使用同种异体骨组（21.4%）（p<.001）。感染率（分别为 7.9%和 9%）和骨折率（分别为 19.6%和 19.1%）没有统计学差异。带 VFG 的同种异体骨组的假体取出率（6.57%）也明显低于单独使用同种异体骨组（18.11%）（p<.001）。通过肌肉骨骼肿瘤协会评分（88.22%和 87.77%）测量，功能结果在各组之间相似。
与单独使用同种异体骨重建相比，同种异体骨重建加补块 VFG 可降低骨下肢肿瘤切除后骨重建的非融合和假体取出风险。在肿瘤切除后下肢重建的手术计划中，这种技术值得更多考虑。
