FRACTURES OF ALLOGRAFTS - FREQUENCY, TREATMENT, AND END-RESULTS
FRACTURES OF ALLOGRAFTS - FREQUENCY, TREATMENT, AND END-RESULTS
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DOI：
10.2106/00004623-199072060-00005
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发表时间：
1990-07-01
影响因子：
5.3
通讯作者：
MANKIN, HJ
中科院分区：
文献类型：
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作者：
BERREY, BH;LORD, CF;MANKIN, HJ
在肿瘤治疗中植入大量冷冻尸体同种异体移植物的主要并发症之一是同种异体移植物的断裂。为了确定这种并发症的发生率、危险因素、适当的管理和治疗结果，对马萨诸塞州总医院[美国马萨诸塞州波士顿]骨科肿瘤科的记录进行了审查。经鉴定，有 43 名患者的肿瘤曾接受过同种异体移植物治疗，但随后发生骨折。骨折的总体发生率几乎为 16%。当将 43 名骨折患者的几个危险因素（患者年龄和性别、病变分期和部位等）与该系列其他患者进行比较时，唯一的相关性是宿主-供体交界处不愈合的发生率，而骨折患者的不愈合发生率明显更高。术后平均骨折时间为 28.6 个月。发生了三种类型的骨折： I 型（两名患者），移植物快速溶解； II型（22名患者），骨干骨折，男性患者更常见，平均发生在术后27.6个月； III 型（19 名患者），关节碎裂，通常发生较晚（平均术后 31.6 个月），并且在女性患者中更常见。除四例骨折（仅固定后愈合）外，所有骨折均通过手术治疗，最初包括切开复位、更换内固定装置和添加自体移植物（主要用于 II 型骨折）或传统的全关节置换术（主要用于 III 型骨折）。治疗后，同种异体移植物骨折的患者的结果与整个系列的结果相近；每组超过 75% 的结果都是优秀或良好。这些数据表明，同种异体移植物骨折的并发症没有最初想象的那么严重。
One of the major complications of implantation of a massive frozen cadaveric allograft in the treatment of a tumor is fracture of the allograft. To determine the incidence, risk factors, appropriate management, and results of treatment of this complication, the records of the Orthopaedic Oncology Unit of the Massachusetts General Hospital [Boston, Massachusetts, USA] were reviewed. Forty three patients were identified in whom a tumor had been treated with an allograft that had subsequently fractured. The over-all incidence of fracture was almost 16 per cent. When the several risk factors (age and sex of the patient, stage and site of the lesion, and so on) for the forty-three patients who had a fracture were compared with those for the rest of the series, the only correlation was the incidence of non-union at the site of the host-donor junction, which was significantly higher in the patients who had a fracture. The mean time to fracture was 28.6 months after the operation. Three types of fractures occurred: Type I (two patients), rapid dissolution of the graft; Type II (twenty-two patients), fracture of the shaft, which was observed more frequently in male patients and which occurred a mean of 27.6 months after the operation; and Type III (nineteen patients), fragmentation of the joint, which usually occurred later (a mean of 31.6 months postoperatively) and was found more frequently in female patients. All but four of the fractures (which healed after immobilization alone) were treated with an operation, which consisted initially of either open reduction, replacement of an internal fixation device, and addition of autogenous graft (mostly for Type-II fractures) or of conventional total joint replacement (mostly for Type-III fractures). After treatment, the results for the patients in whom the allograft had fractured approximated those for the entire series; the result was excellent of good in more than 75 per cent of each group. These data suggest that fracture of an allograft is a less severe complication than was originally thought.