Large segment allograft survival is improved with intramedullary cement
Large segment allograft survival is improved with intramedullary cement
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DOI：
10.1002/jso.10316
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发表时间：
2003-12-01
影响因子：
2.5
通讯作者：
Wunder, JS
中科院分区：
文献类型：
--
作者：
Gerrand, CH;Griffin, AM;Wunder, JS
背景和目的：大段同种异体骨移植用于肿瘤重建失败的最常见原因是同种异体骨骨折。加压髓内骨水泥加固可能会提高同种异体骨的机械性能。方法：我们回顾了前瞻性收集的45例患者进行整块切除四肢骨肿瘤和重建使用同种异体骨与髓内cement.Results：7同种异体骨用于关节融合术，20间，18骨软骨。45例患者中有28例存活，平均5.8年（SD 1.9;范围3-11.2），24例原位同种异体移植。在这45例患者中，有4例同种异体移植物骨折和4例感染。其中6例并发症导致同种异体移植物取出。估计5年同种异体移植物存活率为86%（95%置信区间74-98%）。7名患者需要二次自体骨移植治疗骨不连。通过多伦多生存挽救评分和1987年和1993年肌肉骨骼肿瘤协会评定量表测量的功能表明，骨软骨同种异体移植患者的功能较差，而椎间同种异体移植患者的功能最好。这些结果表明，在大段同种异体骨移植物中加入髓内骨水泥可通过降低骨折风险提高其存活率，特别是用于关节固定术和夹层重建的同种异体移植物。(C)2003 Wiley-Liss，Inc.
Background and Objectives: The most common cause of failure in large segment bone allografts used for oncologic reconstruction is allograft fracture. Reinforcement with pressurized intramedullary cement may improve the mechanical properties of allografts.Methods: We reviewed the prospectively collected records of 45 patients who underwent en bloc resection of an extremity bone tumor and reconstruction using an allograft with intramedullary cement.Results: Seven allografts were used for arthrodesis, 20 were intercalary, and 18 were osteochondral. Twenty eight of 45 patients were alive at a mean 5.8 years (SD 1.9; range 3-11.2) with 24 allografts in situ. In these 45 patients, there were four allograft fractures and four infections. Six of these complications resulted in allograft removal. The estimated 5-year allograft survival rate was 86% (95% confidence interval 74-98%). Seven patients required secondary autogenous bone grafting for non-unions. Function measured by the Toronto Extremity Salvage Score and the 1987 and 1993 Musculoskeletal Tumor Society Rating Scales demonstrated a consistent pattern with worse function in patients with osteochondral allografts and best function with intercalary allografts.Conclusions: These results suggest the addition of intramedullary cement to large segment bone allografts improves their survival by decreasing the fracture risk, particularly for allografts used for arthrodesis and intercalary reconstructions. (C) 2003 Wiley-Liss, Inc.