张翼;张岩;李甲振;卢新昌;张彬;刘永奎;

• 1:郑州大学第一附属医院骨科

摘要(Abstract)：

[目的]探讨同种异体骨移植修复重建四肢恶性骨肿瘤切除后骨缺损的临床疗效。[方法] 2013年6月～2017年12月对本院收治的21例四肢恶性骨肿瘤切除后骨缺损病例进行大段同种异体骨移植重建,其中复合肿瘤型人工关节置换12例,单纯异体骨段移植9例。本组病例男13例,女8例;年龄11～51岁,平均(21.53±6.54)岁,均经过术前穿刺活检及术后病理确诊,Enneking分期ⅠB期4例,ⅡB期17例,其中骨肉瘤和尤文肉瘤患者术前均行2个疗程新辅助化疗及术后规范化疗。术后采用MSTS评分进行功能评价。[结果]所有患者获随访8～48个月,平均(29.64±11.22)个月,均未发生移植异体骨或假体周围骨折,无关节脱位及假体松动。其中19例肢体功能优良,MSTS功能评分16～28分,平均(22.82±4.47)分。[结论]异体骨移植联合肿瘤型人工关节复合置换,以及异体骨段移植重建长骨干缺损仍然是治疗四肢恶性骨肿瘤切除后骨缺损的一种有效重建方法。

关键词(KeyWords)： 异体骨移植;恶性骨肿瘤;骨缺损;肿瘤型人工关节置换

Abstract:

Keywords:

基金项目(Foundation): 河南省科技计划项目(编号:182102310370);; 河南省基础与前沿技术研究计划项目(编号:142300410400)

作者(Author): 张翼;张岩;李甲振;卢新昌;张彬;刘永奎;

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参考文献(References)：

• [1]Levin AS,Arkader A,Morris CD.Reconstruction following tumor resections in skeletally immature patients[J].J Am Acad OrthopSurg,2017,25(3):204-213.
• [2]Wee J,Thevendran G.The role of orthobiologics in foot and ankle surgery:allogenic bone grafts and bone graft substitutes[J].EFORT Open Rev,2017,2(6):272-280.
• [3]Yang Y,Han L,He Z,et al.Advances in limb salvage treatment of osteosarcoma[J].J Bone Oncol,2017,10(1):36-40.
• [4]Han G,Bi WZ,Xu M,et al.Amputation versus limb-salvage surgery in patients with osteosarcoma:a meta-analysis[J].World JSurg,2016,40(8):2016-2027.
• [5]Biazzo A,De Paolis M.Multidisciplinary approach to osteosarcoma[J].Acta Orthop Belg,2016,82(4):690-698.
• [6]Min L,Zhou Y,Tang F,et al.Reconstruction with scapular hemiarthroplastyendoprosthesis after scapulectomy for malignant tumour[J].Int Orthop,2017,41(5):1057-1063.
• [7]Craig R,Vlychou M,McCarthy CL,et al.Metal wear-induced pseudotumour following an endoprosthetic knee replacement for Ewing sarcoma[J].Skeletal Radiol,2017,46(7):967-974.
• [8]Zhang C,Hu J,Zhu K,et al.Survival,complications and functional outcomes of cemented megaprostheses for high-grade osteosarcoma around the knee[J].Int Orthop,2018,42(4):927-938.
• [9]Yoshida Y,Okamura Y,Akita M,et al.Two revision surgeries on cemented custom-made tumor prostheses[J].Acta Med Okayama,2017,71(1):69-72.
• [10]Kawai A,Muschler GF,Lane JM,et al.Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur.Medium to long-term results[J].J Bone Joint Surg Am,1998,80(5):636-647.
• [11]Wilson RJ,Sulieman LM,VanHouten JP,et al.Cost-utility of osteoarticular allograft versus endoprosthetic reconstruction for primary bone sarcoma of the knee:A markov analysis[J].J Surg Oncol,2017,115(3):257-265.
• [12]Gupta S,Kafchinski LA,Gundle KR,et al.Intercalary allograft augmented with intramedullary cement and plate fixation is a reliable solution after resection of a diaphysealtumour[J].Bone Joint J,2017,99-B(7):973-978.
• [13]Gross CE,Huh J,Green C,et al.Outcomes of bone grafting of bone cysts after total ankle arthroplasty[J].Foot Ankle Int,2016,37(2):157-164.
• [14]汤小东,郭卫,杨荣利,等.异体骨移植重建四肢肿瘤切除后的骨缺损[J].中国修复重建外科杂志,2006,20(10):985-988.
• [15]黄长明,王臻,童星杰,等.大段异体骨移植治疗骨肿瘤[J].中华骨科杂志,2000,20(7):406-409.
• [16]Gautam D,Malhotra R,Dubey S.Combination drug chemotherapy and massive skeletal allograft in the management of hydatid disease of femur[J/OL].BMJ Case Rep,2018,epub ahead of print,pii:bcr-2017-223332.
• [17]Asavamongkolkul A,Waikakul S.Plate fixation technique for reducing osteoarticular allograft fracture:a preliminary report[J].JMed Assoc Thai,2016,99(10):1110-1118.
• [18]Xu L,Zhou J,Wang Z,et al.Reconstruction of bone defect with allograft and retrograde intramedullary nail for distal tibia osteosarcoma[J].Foot Ankle Surg,2018,24(2):149-153.
• [19]王臻,刘继中,胡蕴玉,等.异体骨关节移植后骨愈合的X线形式及影响因素[J].中国修复重建外科杂志,2003,17(4):303-307.2018-10-25