Tsuchiya H, Tomita K, Minematsu K, Mori Y, Asada N, Kitano S
Department of Orthopedic Surgery, School of Medicine, Kanazawa University, Japan.
J Bone Joint Surg Br. 1997 May;79(3):403-11. doi: 10.1302/0301-620x.79b3.7198.
We report the results of distraction osteogenesis (callotasis) for the reconstruction of extensive defects after the excision of skeletal tumours in the limbs. Bone transport was performed in ten patients (five osteosarcomas and five giant-cell tumours), shortening-distraction in three (two osteosarcomas and one Ewing's sarcoma), and distraction osteogenesis combined with an intramedullary nail to reduce the time of external fixation in six (three osteosarcomas, two chondrosarcomas, and one malignant fibrous histiocytoma). The mean length of the defects after excision of the lesion was 8.4 cm. The mean external fixation index was 39.5 days/cm for the group treated by bone transport, 34.1 days/cm for the shortening-distraction group, and 24.0 days/cm for the group treated by distraction and an intramedullary nail. Functional evaluation gave excellent results in 12 patients, good in five and fair in two. There were ten complications in 19 patients, all of which were successfully treated. We also classified reconstruction using distraction osteogenesis into five types based on the location of the defects after resection of the tumour: type 1, diaphyseal; type 2, metaphyseal; type 3, epiphyseal; type 4, subarticular reconstruction; and type 5, arthrodesis. Our results suggest that reconstruction using distraction osteogenesis provides bone which will develop sufficient biomechanical strength and durability. It is beneficial in patients with an expectation of long-term survival and in growing children.
我们报告肢体骨骼肿瘤切除术后采用骨搬运成骨术（骨痂延长术）重建大面积骨缺损的结果。对10例患者（5例骨肉瘤和5例骨巨细胞瘤）实施了骨搬运，对3例患者（2例骨肉瘤和1例尤因肉瘤）实施了缩短-延长术，对6例患者（3例骨肉瘤、2例软骨肉瘤和1例恶性纤维组织细胞瘤）实施了骨搬运成骨术联合髓内钉以缩短外固定时间。病变切除后缺损的平均长度为8.4厘米。骨搬运治疗组的平均外固定指数为39.5天/厘米，缩短-延长术组为34.1天/厘米，骨搬运联合髓内钉治疗组为24.0天/厘米。功能评估结果为，12例患者优，5例患者良，2例患者可。19例患者出现10例并发症，均成功治愈。我们还根据肿瘤切除后缺损的部位将采用骨搬运成骨术的重建方式分为5种类型：1型，骨干型；2型，干骺端型；3型，骨骺型；4型，关节下重建型；5型，关节融合型。我们的结果表明，采用骨搬运成骨术进行重建可提供具有足够生物力学强度和耐久性的骨组织。这对于预期长期存活的患者以及正在生长发育的儿童有益。
