Alman B A, De Bari A, Krajbich J I
Hospital for Sick Children, Toronto.
J Bone Joint Surg Am. 1995 Jan;77(1):54-64. doi: 10.2106/00004623-199501000-00008.
A retrospective review was performed of the results of all allograft reconstructions that had been done after the resection of an osteosarcoma or an Ewing sarcoma in a skeletally immature patient between 1982 and 1989 at The Hospital for Sick Children in Toronto. There were twenty-six patients. Six reconstructions were intercalary, sixteen were resection arthrodeses, three followed resection of a bone segment including the epiphysis (osteoarticular reconstruction), and one was a replacement of the entire humerus. Resection arthrodesis about the knee was performed with a smooth intramedullary rod and with one growth plate left intact. Six procedures were performed in the upper extremity. Excluding the patients who died, the average duration of follow-up was five years and three months. Twenty-one of the twenty-six patients had reached skeletal maturity at the time of follow-up. Eighteen (69 per cent) of the patients had a good or excellent result, four (15 per cent) had a fair result, and four had a failure. Twenty patients (77 per cent) had at least one complication (other than a limb-length discrepancy), and fourteen (54 per cent) sustained at least one fracture of the allograft. Fifteen patients who had had a reconstruction in the lower extremity had survived with survival of the allograft at the time of the latest follow-up. A limb-length discrepancy of at least two centimeters developed in nine of the fifteen patients. Five were managed with a contralateral epiphyseodesis, and one of them had an unsuccessful attempt at limb-lengthening as well. The patients who had a limb-length discrepancy of more than three centimeters at the time of follow-up had been significantly younger (p < 0.05) at the time of the reconstruction than those who had a smaller discrepancy. Three allografts (12 per cent), two of which were implanted early in the series, became infected. Soft-tissue coverage is of paramount importance for the prevention of infection, and we now routinely perform primary muscle (gastrocnemius or latissimus dorsi) transfers when dealing with an inadequate muscle envelope. Twelve patients were followed for more than four years (average, six years and seven months); they had no complications other than increased limb-length discrepancy and one subluxation of the shoulder after the first four years following the reconstruction. Although the rate of complications is higher than in adults, allograft reconstruction remains a useful option for the management of skeletally immature individuals.(ABSTRACT TRUNCATED AT 400 WORDS)
对1982年至1989年间在多伦多病童医院为骨骼未成熟患者切除骨肉瘤或尤文肉瘤后进行的所有同种异体移植重建结果进行了回顾性研究。共有26例患者。6例为节段性重建，16例为切除关节固定术，3例为包括骨骺的骨段切除后重建（骨关节重建），1例为全肱骨置换。膝关节周围的切除关节固定术采用光滑的髓内棒进行，保留一个生长板完整。6例手术在上肢进行。排除死亡患者后，平均随访时间为5年3个月。26例患者中有21例在随访时达到骨骼成熟。18例（69%）患者结果良好或优秀，4例（15%）结果尚可，4例失败。20例（77%）患者至少有一项并发症（肢体长度差异除外），14例（54%）同种异体移植至少发生一次骨折。15例下肢进行重建的患者存活，在最近一次随访时同种异体移植存活。15例患者中有9例出现至少2厘米的肢体长度差异。5例通过对侧骨骺固定术处理，其中1例肢体延长尝试失败。随访时肢体长度差异超过3厘米的患者在重建时年龄明显更小（p<0.05），与差异较小的患者相比。3例同种异体移植（12%）发生感染，其中2例在该系列早期植入。软组织覆盖对于预防感染至关重要，我们现在在处理肌肉覆盖不足时常规进行一期肌肉（腓肠肌或背阔肌）转移。12例患者随访超过4年（平均6年7个月）；除肢体长度差异增加和重建后前四年有1例肩关节半脱位外，无其他并发症。尽管并发症发生率高于成人，但同种异体移植重建仍是管理骨骼未成熟个体的有用选择。（摘要截断于400字）
