Intercalary defects reconstruction of the femur and tibia after primary malignant bone tumour resection. A series of 13 cases
Intercalary defects reconstruction of the femur and tibia after primary malignant bone tumour resection. A series of 13 cases
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DOI：
10.1016/j.otsr.2011.03.021
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发表时间：
2011-09-01
影响因子：
2.3
通讯作者：
Biau, D.
中科院分区：
文献类型：
--
作者：
Brunet, O.;Anract, P.;Biau, D.
简介：恶性骨肿瘤切除后进行闰段重建会带来机械和生物学方面的挑战。固定必须足够牢固，以避免短期或中期机械故障。使用同种异体移植物或自体移植物必须确保重建的长期存活。本研究的目的是分析这些重建的临床和放射学结果。患者和方法：13 名患者接受了 8 根股骨和 5 根胫骨的手术。中位年龄为 20 岁（范围 14-50 岁）。最常见的诊断是骨肉瘤。中位切除长度为 15 cm（Q1-Q3：6-26）。采用钢板固定9例，髓内钉固定4例。采用自体离体骨移植 2 例，同种异体离体骨移植 1 例，自体-同种异体双骨复合 6 例，带血管腓骨与同种异体骨联合 4 例。 结果：1 年累积愈合概率为 46%（95% CI：0-99%）；在最后一次随访时，12 名患者 (92%) 实现愈合。由于不联合，需要 13 次迭代过程才能获得这些结果。 1例患者长方体胫骨移植物发生非移位性骨折，经保守治疗。发生3例感染。讨论：骨肿瘤切除术后居间节段缺损重建无论从肿瘤学还是放射学角度均取得了良好的效果。有时需要一次或多次迭代程序才能最终获得骨愈合。我们更喜欢使用游离的矩形立方体胫骨移植物，因为使用带血管的自体移植物进行重建在技术上更加困难。固定方法的选择仍然存在争议，没有发现任何方法更优越。证据级别：IV级。回顾性研究。 (C) 2011 年由 Elsevier Masson SAS 出版。
Introduction: Performing intercalary segment reconstruction after malignant bone tumour resection results in both mechanical and biological challenges. Fixation must be solid enough to avoid short-term or mid-term mechanical failure. The use of an allograft or autograft must ensure long-term survival of the reconstruction. The goal of this study was to analyse the clinical and radiological outcomes of these reconstructions.Patients and methods: Thirteen patients were operated on eight femurs and five tibias. The median age was 20 years old (range 14-50). The most common diagnosis was osteosarcoma. The median resection length was 15 cm (Q1-Q3: 6-26). A plate was used for fixation in nine cases and an intramedullary locked nail in four cases. An isolated bone autograft was used in two cases, an isolated bone allograft in one case, a dual autograft-allograft composite in six cases, and vascularised fibula and allograft combination in four cases.Results: The cumulative probability of union was 46% (95% CI: 0-99%) at 1 year; at the final follow-up, union was achieved in 12 patients (92%). Because of non-unions, 13 iterative procedures were needed to obtain these results. A non-displaced fracture of a cuboid-shaped tibial graft occurred in one patient, which was treated conservatively. Three infections occurred.Discussion: The results of intercalary segmental defects reconstruction after bone tumour resection were good, both from an oncologic and radiological point-of-view. One or more iterative procedures are sometimes needed to finally obtain bone union. We prefer to use a free rectangular cuboidal tibial graft since reconstruction with a vascularised autograft is technically more difficult. The choice of fixation methods is still controversial and no approach was found to be superior.Level of evidence: Level IV. Retrospective study. (C) 2011 Published by Elsevier Masson SAS.