The results of transplantation of intercalary allografts after resection of tumors - A long-term follow-up study
The results of transplantation of intercalary allografts after resection of tumors - A long-term follow-up study
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DOI：
10.2106/00004623-199701000-00010
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发表时间：
1997-01-01
影响因子：
5.3
通讯作者：
Mankin, HJ
中科院分区：
文献类型：
--
作者：
OrtizCruz, E;Gebhardt, MC;Mankin, HJ
我们回顾了1974年4月至1992年8月间在100名患者中进行的104例异体骨移植手术的结果，这些患者通常是在因骨肿瘤切除骨段后进行的。随访的中位时间为5.6年，移植物保留和恢复基本正常的功能是成功的指标，在此基础上，八十七104例重建成功率为84%，15例重建失败的肢体中，4例通过植入第二个同种异体移植物挽救，3例通过使用其他技术挽救。（包括两名复发肿瘤的患者）随后截肢;因此，整个系列的最终挽救率为92%，31例移植物在术后一年内未能与宿主的一个连接处或两个连接处结合，寿命表回归分析显示年龄、性别、解剖部位和移植物长度与总体结局无显著差异。感染（p = 0.0001）;骨折（p = 0.002）;病变分期（p = 0.007）;以及使用辅助化疗或放疗，或两者兼而有之（p = 0.008），均对同种异体移植物的存活产生不利影响。尽管骨不连的发生率相对较高，需要额外的手术，这些数据表明，移植同种异体移植物治疗中间缺损具有很高的成功率，并且通常导致功能性肢体。
We reviewed the results of 104 intercalary allograft procedures that had been performed, between April 1974 and August 1992, in 100 patients, usually after resection of a segment of bone because of an osseous neoplasm, The median duration of follow-up was 5.6 years, Retention of the graft and return to essentially normal function were the measures of success and, on that basis, eighty-seven (84 per cent) of the 104 reconstructions were successful, Of the fifteen limbs in which the reconstruction failed, four were salvaged with insertion of a second allograft and three, with use of some other technique.Of the 104 allograft procedures, eight (including two in patients who had a recurrent tumor) were followed by an amputation; thus, the ultimate rate of salvage was 92 per cent for the entire series, Thirty-one grafts failed to unite at one junction with the host or both, within one year after the operation, and this necessitated eighty-one additional operative procedures to achieve a good result.Life-table regression analysis showed that age, gender, anatomical site, and length of the graft were not associated with significant differences in the over-all outcome. Infection (p = 0.0001); fracture (p = 0.002); stage of the lesion (p = 0.007); and use of adjuvant chemotherapy or radiation, or both (p = 0.008), all had an adverse effect on the survival of the allograft.Despite the relatively high rate of non-union that necessitated additional operations, these data indicate that transplantation of allografts for the treatment of intercalary defects has a high rate of success and usually results in a functional limb.