Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.
Eur J Med Res. 2021 Oct 2;26(1):118. doi: 10.1186/s40001-021-00593-9.
Large bone defects resulting from musculoskeletal tumours, infections, or trauma are often unable to heal spontaneously. The challenge for surgeons is to avoid amputation, and provide the best functional outcomes. Allograft, vascularized fibular or iliac graft, hybrid graft, extracorporeal devitalized autograft, distraction osteogenesis, induced-membrane technique, and segmental prostheses are the most common surgical strategies to manage large bone defects. Given its optimal osteogenesis, osteoinduction, osteoconduction, and histocompatibility properties, along with the lower the risk of immunological rejection, autologous graft represents the most common used strategy for reconstruction of bone defects. However, the choice of the best surgical technique is still debated, and no consensus has been reached. The present study investigated the current reconstructive strategies for large bone defect after trauma, infections, or tumour excision, discussed advantages and disadvantages of each technique, debated available techniques and materials, and evaluated complications and new perspectives.
由于肌肉骨骼肿瘤、感染或创伤而导致的大骨缺损通常无法自发愈合。外科医生面临的挑战是避免截肢，并提供最佳的功能结果。同种异体骨、带血管腓骨或髂骨移植物、杂交移植物、体外去细胞化自体移植物、牵张成骨术、诱导膜技术和节段性假体是治疗大骨缺损最常见的手术策略。由于具有最佳的成骨、成骨诱导、骨传导和组织相容性特性，以及免疫排斥反应的风险较低，自体移植物是重建骨缺损最常用的策略。然而，最佳手术技术的选择仍存在争议，尚未达成共识。本研究探讨了创伤、感染或肿瘤切除后大骨缺损的当前重建策略，讨论了每种技术的优缺点，辩论了可用的技术和材料，并评估了并发症和新视角。
