Bone defect reconstruction with autologous bone inactivated with liquid nitrogen after resection of primary limb malignant tumors An observational study
Bone defect reconstruction with autologous bone inactivated with liquid nitrogen after resection of primary limb malignant tumors An observational study
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DOI：
10.1097/md.0000000000020442
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发表时间：
2020-06-01
期刊：
影响因子：
1.6
通讯作者：
Niu, Xiaohui
中科院分区：
文献类型：
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作者：
Li, Yuan;Yang, Yongkun;Niu, Xiaohui
恶性骨肿瘤的外科治疗包括肿瘤切除和重建。最常用的重建方法是假体置换，其早期功能良好，但远期并发症发生率高。另一种重建选择是自体骨再植，其优点是解剖匹配，不需要大型骨库支持。很少有研究评价液氮灭活自体骨重建。本研究旨在评价液氮灭活自体骨移植重建的肿瘤学结果、骨愈合结果、并发症和适应症。研究人群包括21例连续患者。肿瘤发生在胫骨9例，股骨8例，肱骨4例。共37个截骨端。冷冻复温后，用抗生素骨水泥填充自体骨的髓腔。17例行双侧钢板内固定，2例行髓内钉加远端钢板内固定，2例行单钢板内固定，平均随访31 ± 6个月。18例无瘤生存，3年生存率为80.4%。所有病例均有足够的手术切缘，但有1例复发。3例发生转移，均死于转移。1例患者术中发生灭活骨折，1例患者发现螺钉断裂。1例肱骨干截骨部位发生骨不连，1例患者失访;其余35端平均愈合时间为13 ± 6个月，骨愈合率为97.2%。干骺端和骨干的平均骨愈合时间分别为9 +/- 3个月和15 +/- 6个月（P=.003）。上肢和下肢的平均骨愈合时间分别为16.6 +/- 7.4个月和12.3 +/- 5.8个月（P= 0.020）。18例存活者平均肌肉和骨骼肿瘤学会评分为28 ± 3（21-30）分。液氮灭活自体骨再植治疗原发性四肢恶性肿瘤安全有效，并发症发生率低，骨愈合率高，术后功能满意。对于具有特定部位和骨质破坏特点的恶性骨肿瘤，此方法是一种可靠的生物学重建方法。
Surgical treatment of malignant bone tumors comprises tumor resection and reconstruction. The most commonly used reconstruction method is prosthesis replacement, which achieves good early function, but has a high long-term incidence of complications. Another reconstruction option is autologous bone replantation, which has the advantages of anatomical matching and no need for large bone bank support. Few studies have evaluated reconstruction with liquid nitrogen-inactivated autogenous bone.The present study aimed to evaluate the oncological results, bone healing results, complications, and indications of reconstruction with liquid nitrogen-inactivated autogenous bone grafts.The study population comprised 21 consecutive patients. The tumor site was the tibia in 9 cases, femur in 8, and humerus in 4. There were 37 osteotomy ends in total. After freezing and rewarming, the medullary cavity of the autogenous bone was filled with antibiotic bone cement. Seventeen patients received bilateral plate fixation, 2 received intramedullary nail and distal plate fixation, and 2 received single plate fixation.The average follow-up was 31 +/- 6 months. Eighteen patients survived without tumors, and the 3-year survival rate was 80.4%. All cases had adequate surgical margins, but recurrence developed in 1 patient. Metastasis occurred in 3 patients, who all died of metastasis. Intraoperative inactivated bone fracture occurred in 1 patient, and screw breakage was found in 1 patient. Nonunion occurred at 1 humeral diaphysis osteotomy site, and 1 patient was lost to follow-up; the average healing time of the other 35 ends was 13 +/- 6 months, and the bone healing rate was 97.2%. The average bone healing times in the metaphysis and diaphysis were 9 +/- 3 months and 15 +/- 6 months (P=.003). The average bone healing times in the upper and lower limbs were 16.6 +/- 7.4 months and 12.3 +/- 5.8 months (P=.020). The average Muscle and Skeletal Tumor Society score was 28 +/- 3 (21-30) in the 18 survivors.Liquid nitrogen-inactivated autologous bone replantation for primary malignant limb tumor was safe and effective, as shown by the relatively low complication rate, high bone healing rate, and satisfactory postoperative function. This is a reliable biological reconstruction method for malignant bone tumors with specific site and bone destruction characteristics.