Tigani D, Donati D, Moscato M, De Iure F, Boriani S
Clinica Ortopedica dell'Università di Bologna, Istituti Ortopedici Rizzoli.
Chir Organi Mov. 1996 Jan-Mar;81(1):31-41.
The authors report 38 reconstruction by Grosse-Kempf nailing for resection of bone tumor; there were: intercalar resections: 16; arthrodeses of the knee: 13; arthrodesis of the ankle joint: 5; gyroplasty: 4. Massive homoplastic bone graft was used in 26 cases, in 3 of which autoplastic grafting was associated; autoplastic grafts were used exclusively in 7 cases, and a cement spacer was used in 1. Twenty-nine patients (76%) obtained satisfactory final results, but in 10 cases secondary surgery was performed for a total of 14 operations, of which 7 major (1 nail substitution and 6 vascularized fibula operations). There were 7 failures: mechanical complications: 6; infection: 1. The highest number of non-unions were observed where massive homoplastic grafting was used: intercalar reconstruction: 11; arthrodesis of the knee: 7. The results were evidently better and the incidence of complications low in cases in which autoplastic grafting was used or where gyroplasty was performed. Absolute stiffness and best possible contact are difficult to obtain with blocked intramedullary nailing. On the contrary, when autoplastic grafts are used or when gyroplasty is performed micromovements allowed the instrumentation are compatible with good consolidation.
作者报告了38例采用Grosse-Kempf髓内钉技术进行骨肿瘤切除术后重建的病例；具体情况如下：节段性切除16例；膝关节融合术13例；踝关节融合术5例；旋转成形术4例。26例使用了大块同种异体骨移植，其中3例联合自体骨移植；7例仅使用自体骨移植，1例使用了骨水泥间隔物。29例患者（76%）获得了满意的最终结果，但10例患者接受了二次手术，共进行了14次手术，其中7次为大手术（1次更换髓内钉和6次带血管腓骨手术）。有7例失败：机械并发症6例；感染1例。在使用大块同种异体骨移植的病例中观察到的骨不连数量最多：节段性重建11例；膝关节融合术7例。在使用自体骨移植或进行旋转成形术的病例中，结果明显更好，并发症发生率较低。采用锁定髓内钉难以获得绝对的刚度和最佳的接触。相反，当使用自体骨移植或进行旋转成形术时，允许的微动与良好的骨愈合是相容的。
