Van Laere K, Casier K, Uyttendaele D, Mondelaers W, De Sadeleer C, Simons M, Dierckx R
Department of Orthopedic Surgery, University Hospital Gent, Belgium.
J Nucl Med. 1998 Sep;39(9):1563-9.
Local malignant bone tumor excision followed by high-dose extracorporeal irradiation (300 Gy) and subsequent reimplantation is a unique technique for treatment of primary bone and cartilage tumors. The long-term scintigraphic findings of irradiated bone autografts in relation to clinical patient data were reviewed retrospectively.
Thirty-seven patients (12 women, 25 men; age range 13.0-66.7 yr; average age 29.1 yr) were studied. Postsurgical anatomopathological diagnoses included osteosarcoma, 20 patients; chondrosarcoma, 7 patients; and other less-frequent primary osteogenic tumors, 10 patients. Three hundred ninety 99mTc-methylene diphosphonate (MDP) whole-body scans performed between 3 mo and 18.3 yr (mean 6.5 yr) after treatment were reviewed.
The 10-yr actuarial survival rate was 78%. After a mean period of 19.4 mo, 6 patients developed a local recurrence, and MDP scintigraphy detected the recurrence in 4. Distant metastases developed in 11 patients (30%), of which 10 were nonosseous. Initially, all autografts appeared as photon-deficient areas. Diffusely increased bone uptake was present at osteotomy sites and at articulating surfaces contiguous with autografts within the first few months after surgery. Of all 25 patients with adequate follow-up, 7 showed persistent decreased uptake up to 129 mo after surgery. The other patients developed partial tracer uptake after 19.6 mo, on average. In 6 patients, scintigraphic images consistent with complete revascularisation were noted later (mean 31.5 mo). Local, sometimes multiple, complications were noted in 22 patients, mainly mechanical graft-related (15) or infections (11). Scintigraphic sensitivity for mechanical complications was 100%. Significantly more fractures and collapses were seen when partial tracer uptake suggestive of revascularisation occurred. Altered bone stress gave rise to focal and diffuse scintigraphic abnormalities, often in the spine and lower extremities. In recent literature, similar clinical complication patterns are found for massive allografts.
Skeletal scintigraphy is a sensitive technique for evaluating long-term follow-up of massive grafts to treat primary malignant bone tumors. Revascularisation and partial bone ingrowth are not sufficient conditions for a lower complication rate.
局部恶性骨肿瘤切除后进行大剂量体外照射（300Gy）并随后再植入是治疗原发性骨和软骨肿瘤的一种独特技术。回顾性分析了经照射的自体骨移植的长期骨闪烁显像结果及其与临床患者数据的关系。
研究了37例患者（12例女性，25例男性；年龄范围13.0 - 66.7岁；平均年龄29.1岁）。术后解剖病理诊断包括骨肉瘤20例；软骨肉瘤7例；以及其他较少见的原发性骨源性肿瘤10例。回顾了治疗后3个月至18.3年（平均6.5年）期间进行的390次99m锝 - 亚甲基二膦酸盐（MDP）全身扫描。
10年精算生存率为78%。平均19.4个月后，6例患者出现局部复发，MDP骨闪烁显像检测到其中4例复发。11例患者（30%）发生远处转移，其中10例为非骨转移。最初，所有自体骨移植均表现为光子缺乏区。术后头几个月，截骨部位以及与自体骨移植相邻的关节面出现弥漫性骨摄取增加。在所有25例有充分随访的患者中，7例在术后129个月时骨摄取持续降低。其他患者平均在19.6个月后出现部分示踪剂摄取。6例患者后来出现与完全血管再通一致的骨闪烁显像图像（平均31.5个月）。22例患者出现局部并发症，有时为多发，主要是与移植相关的机械性并发症（15例）或感染（11例）。机械性并发症的骨闪烁显像敏感性为100%。当出现提示血管再通的部分示踪剂摄取时，骨折和塌陷明显增多。骨应力改变导致局部和弥漫性骨闪烁显像异常，常见于脊柱和下肢。在最近的文献中，大量同种异体骨移植也有类似的临床并发症模式。
骨闪烁显像是评估治疗原发性恶性骨肿瘤的大块移植长期随访的一种敏感技术。血管再通和部分骨长入不足以降低并发症发生率。
