Department of Orthopaedics, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
Sci Rep. 2021 Oct 14;11(1):20444. doi: 10.1038/s41598-021-00092-1.
Biological reconstruction is widely used to reconstruct bone defects after resection of bone tumors in the extremities. This study aimed to identify risk factors for failure and to compare outcomes of the allograft, nonvascularized autograft, and recycled frozen autograft reconstruction after resection of primary malignant bone tumors in the extremities. A retrospective study was performed at a single center between January 1994 and December 2017. Ninety patients with primary malignant bone tumors of the extremities were treated with tumor resection and reconstruction using one of three bone graft methods: nonvascularized autograft (n = 27), allograft (n = 34), and recycled frozen autograft (n = 29). The median time for follow-up was 59.2 months (range 24-240.6 months). Overall failure of biological reconstruction occurred in 53 of 90 patients (58.9%). The allograft group had the highest complication rates (n = 21, 61.8%), followed by the recycled frozen autograft (n = 17, 58.6%) and nonvascularized autograft (n = 15, 55. 6%) groups. There was no statistically significant difference among these three groups (p = 0.89). The mean MSTS score was 22.6 ± 3.4 in the nonvascularized autograft group, 23.4 ± 2.6 in the allograft group, and 24.1 ± 3.3 in the recycled frozen autograft group. There was no significant difference among the groups (p = 0.24). After bivariate and multivariable analyses, patient age, sex, tumor location, graft length, methods, and type of reconstruction had no effects on the failure of biological reconstruction. Biological reconstruction using allograft, nonvascularized autograft, and recycled frozen autograft provide favorable functional outcomes despite high complication rates. This comparative study found no significant difference in functional outcomes or complication rates among the different types of reconstruction.
生物重建广泛用于四肢骨肿瘤切除后的骨缺损重建。本研究旨在确定失败的风险因素，并比较四肢原发性恶性骨肿瘤切除后同种异体、非血管化自体和再循环冷冻自体移植重建的结果。这是一项单中心回顾性研究，时间为 1994 年 1 月至 2017 年 12 月。90 例四肢原发性恶性骨肿瘤患者采用肿瘤切除和三种骨移植物方法之一进行重建：非血管化自体（n=27）、同种异体（n=34）和再循环冷冻自体（n=29）。中位随访时间为 59.2 个月（范围 24-240.6 个月）。90 例患者中有 53 例（58.9%）发生生物重建失败。同种异体组并发症发生率最高（n=21，61.8%），其次是再循环冷冻自体组（n=17，58.6%）和非血管化自体组（n=15，55.6%）。三组间无统计学差异（p=0.89）。非血管化自体组 MSTS 评分平均为 22.6±3.4，同种异体组为 23.4±2.6，再循环冷冻自体组为 24.1±3.3。组间无显著差异（p=0.24）。二元和多变量分析后，患者年龄、性别、肿瘤位置、移植物长度、方法和重建类型对生物重建失败无影响。同种异体、非血管化自体和再循环冷冻自体重建虽然并发症发生率高，但提供了良好的功能结果。本比较研究发现，不同类型重建的功能结果或并发症发生率无显著差异。
