Department of Orthopaedic Oncology Surgery, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035, China.
National Center for Orthopedics, Beijing, 100035, China.
J Orthop Traumatol. 2024 Nov 24;25(1):58. doi: 10.1186/s10195-024-00807-w.
This study aims to compare the clinical outcomes of intercalary frozen autograft and allograft reconstruction for primary malignant bone tumors.
A retrospective study was conducted on 144 patients who underwent intercalary biological reconstruction for primary malignant bone tumors at a single institution between January 2012 and July 2023. Seventy-two patients underwent intercalary liquid nitrogen-frozen autograft reconstruction, and 72 patients underwent intercalary allograft reconstruction in this study. A modified International Society of Limb Salvage classification system was used to evaluate the complications.
The mean follow-up time was 60.2 ± 32.1 (range, 12-149) months. The mean union time was 9.6 months in the frozen autograft group and 15.9 months in the allograft group (p < 0.001). The 5-year overall survivorship was 86.8% in the frozen autograft group and 73.2% in the allograft group (p = 0.017). The average MSTS-93 score was comparable between the two groups (89.7% by autograft versus 87.6% by allograft, p > 0.05). Of the patients, 48.6% (70/144) had at least one complication. The most common complications were bone nonunion (20.8%, 30/144), followed by structural failure (17.4%, 25/144), tumor progression (10.4%, 15/144), infection (10.4%, 15/144), and soft tissue failures (5.6%, 8/144). Higher rates of bone nonunion (type 4B; p = 0.002) and structural failure (type 3B; p = 0.004) were obtained in the allograft group than in the frozen autograft group.
The intercalary frozen autografts had shorter union time and lower complication rates than allograft reconstruction. Therefore, we recommend that frozen autograft reconstruction be considered when the tumor bone has not suffered severe osteolytic injury or pathological fracture.
level III, case-control study.
本研究旨在比较冷冻异体骨和同种异体骨重建在原发性恶性骨肿瘤中的临床疗效。
对 2012 年 1 月至 2023 年 7 月在单一机构接受间充质生物重建的 144 例原发性恶性骨肿瘤患者进行回顾性研究。本研究中，72 例患者接受冷冻异体骨重建，72 例患者接受冷冻自体骨重建。采用改良国际保肢协会分类系统评估并发症。
平均随访时间为 60.2±32.1（范围 12-149）个月。冷冻自体骨组的愈合时间为 9.6 个月，异体骨组为 15.9 个月（p<0.001）。冷冻自体骨组的 5 年总生存率为 86.8%，异体骨组为 73.2%（p=0.017）。两组患者的平均 MSTS-93 评分无差异（自体骨 89.7%，异体骨 87.6%，p>0.05）。144 例患者中，48.6%（70/144）至少有 1 种并发症。最常见的并发症是骨不愈合（20.8%，30/144），其次是结构失败（17.4%，25/144）、肿瘤进展（10.4%，15/144）、感染（10.4%，15/144）和软组织失败（5.6%，8/144）。异体骨组骨不愈合（4B 型；p=0.002）和结构失败（3B 型；p=0.004）的发生率均高于冷冻自体骨组。
与同种异体骨重建相比，冷冻自体骨具有愈合时间短、并发症发生率低的优点。因此，我们建议在肿瘤骨未发生严重溶骨性损伤或病理性骨折时，应考虑冷冻自体骨重建。
三级，病例对照研究。
