Haddad Bassem I, Alisi Mohammed S, Yasin Mohamad S, Hamdan Mohammad Q, Abu Hassan Frcs Freih O
Department of Special Surgery, Division of Orthopaedics, School of Medicine, The University of Jordan, Amman, Jordan.
Arch Bone Jt Surg. 2021 Sep;9(5):567-577. doi: 10.22038/abjs.2021.54365.2714.
Reconstruction of large bone defects in skeletally immature patients remains a surgical challenge. We report the long-term clinical outcomes of a novel surgical technique for lower limb reconstruction using the tibia as a strut autograft following resection of primary malignant bone tumors in skeletally immature patients.
We retrospectively reviewed the medical records of six patients diagnosed with lower limb primary bone sarcoma. All patients underwent tumor resection and reconstruction using tibial strut autograft. The radiological and clinical outcomes including complications at the recipient and donor sites were assessed.
The mean age at presentation was ten years (range 6-15 years). Two cases had osteosarcoma and four had Ewing sarcoma. The mean length of the resected tumor and tibial autografts were 20.83 and 19.33 cm respectively. Union at both ends was achieved in five grafts while one graft achieved union only at the distal end. The mean time for union of the proximal and distal junctions was 4 and 8.8 months respectively. The mean follow-up period was 8.4 years (range 14 months-20 years). One patient developed a foot drop, and three patients underwent subsequent joint arthrodesis (2 knees and 1 ankle). The mean musculoskeletal tumor society functional score was 80.8%. Two patients had clinically significant leg-length discrepancy that needs further lengthening procedure. Four patients survived with no evidence of disease and two patients died due to their primary oncologic disease. All donor sites regenerated, with the earliest signs of new bone formation at (2-4) weeks post-operatively.
Reconstruction using non-vascularized tibia strut autograft after resection of primary malignant lower limb bone tumors can be a viable alternative method for reconstructing large bone defects in the immature skeleton.
在骨骼未成熟的患者中重建大的骨缺损仍然是一项外科挑战。我们报告一种新型手术技术的长期临床结果，该技术用于在骨骼未成熟患者的原发性恶性骨肿瘤切除后，使用胫骨作为支撑自体骨进行下肢重建。
我们回顾性分析了6例诊断为下肢原发性骨肉瘤患者的病历。所有患者均接受了肿瘤切除并使用胫骨支撑自体骨进行重建。评估了包括受体和供体部位并发症在内的放射学和临床结果。
就诊时的平均年龄为10岁（范围6 - 15岁）。2例为骨肉瘤，4例为尤因肉瘤。切除肿瘤和胫骨自体骨的平均长度分别为20.83 cm和19.33 cm。5块移植物两端均实现愈合，1块移植物仅在远端实现愈合。近端和远端连接的平均愈合时间分别为4个月和8.8个月。平均随访期为8.4年（范围14个月 - 20年）。1例患者出现足下垂，3例患者随后接受了关节融合术（2例膝关节和1例踝关节）。肌肉骨骼肿瘤学会功能评分平均为80.8%。2例患者存在具有临床意义的腿长差异，需要进一步进行延长手术。4例患者存活且无疾病证据，2例患者因原发性肿瘤疾病死亡。所有供体部位均再生，术后最早在（2 - 4）周出现新骨形成迹象。
在切除原发性恶性下肢骨肿瘤后使用非血管化胫骨支撑自体骨进行重建，可能是在未成熟骨骼中重建大骨缺损的一种可行替代方法。
