Department of Orthopaedic Surgery, Kyoto University, Kyoto, Japan.
Center for iPS Cell Research and Application (CiRA), Kyoto University, Kyoto, Japan.
J Surg Oncol. 2024 Jun;129(7):1364-1373. doi: 10.1002/jso.27629. Epub 2024 Mar 27.
Recycled bone autografts prepared using extracorporeal irradiation (ECIR) or liquid nitrogen freezing (LNF) methods have been used for the reconstruction of skeletal elements after wide resection of sarcomas involving bone tissues. Few reports include long-term follow-up data for histological analyses of recycled autografts, particularly in the case of ECIR autografts.
A total of 34 malignant bone and soft tissue tumors were resected and reconstructed using 11 ECIR- and 23 LNF-recycled autografts; the mean postoperative follow-ups were 14 and 8 years, respectively. ECIR was used for either osteosarcomas or Ewing sarcomas, whereas in addition to these tumors LNF was used for chondrosarcomas and soft tissue sarcomas involving bone tissues. Recycled bone was implanted as total bone, osteoarticular, or intercalary grafts, with or without prosthesis or vascularized fibular grafts.
The 10-year graft survival rate was similar between groups, 81.8% using ECIR and 70.2% using LNF. There were no autograft-related tumor recurrences in either group. Graft survival was unrelated to type of graft or additional procedures. Complication rates tended to be higher using ECIR (64%) compared with LNF (52%) and the infection rate was significantly higher with ECIR (27%) versus LNF (0%). At the final assessment, plain radiographs revealed original recycled bone was present in 7 of 11 ECIR cases and in zero cases treated with LNF autografts, indicating that recycled bone treated with LNF autografts was remodeled into new bone. Histological examination of ECIR-treated bones revealed a delayed and incomplete endochondral ossification process, necrosis and empty lacunae. Conversely, LNF autografts showed remodeled bones with normal trabecular structures.
ECIR and LNF treatment of autografts provided adequate tumor control with acceptable clinical results as a reconstruction method.
采用体外照射（ECIR）或液氮冷冻（LNF）方法制备的再生物自体骨已用于广泛切除涉及骨组织的肉瘤后的骨骼元素重建。很少有报告包括再生物自体骨的长期随访组织学分析数据，尤其是对于 ECIR 自体骨。
共切除 34 例恶性骨和软组织肿瘤，采用 11 例 ECIR 和 23 例 LNF 再生物自体骨重建；平均术后随访分别为 14 年和 8 年。ECIR 用于骨肉瘤或尤文肉瘤，而 LNF 除了这些肿瘤还用于涉及骨组织的软骨肉瘤和软组织肉瘤。再生物骨作为全骨、骨-关节或间插式移植物植入，有无假体或带血管腓骨移植。
两组的 10 年移植物存活率相似，ECIR 组为 81.8%，LNF 组为 70.2%。两组均无自体骨相关肿瘤复发。移植物存活率与移植物类型或附加手术无关。ECIR 组并发症发生率（64%）高于 LNF 组（52%），ECIR 组感染率（27%）明显高于 LNF 组（0%）。在最终评估时，平片显示 11 例 ECIR 病例中有 7 例存在原始再生物骨，而 LNF 自体骨移植无 0 例，表明用 LNF 自体骨治疗的再生物骨已重塑为新骨。ECIR 治疗骨的组织学检查显示出延迟和不完全的软骨内骨化过程、坏死和空骨陷窝。相反，LNF 自体骨显示出具有正常小梁结构的重塑骨。
ECIR 和 LNF 处理的自体骨提供了足够的肿瘤控制，作为一种重建方法具有可接受的临床结果。
