摘要
目的评价应用异体骨重建原发骨巨细胞瘤切除后骨缺损的肢体功能及并发症的发生情况。方法对1992年至2002年进行外科治疗、有完整随访资料的77例骨巨细胞瘤进行回顾分析。外科治疗依据Enneking外科分期原则,进行了肿瘤切除、异体骨重建。采用Mankin评分方法进行功能评定。结果平均随访时间35.3个月。76例患者存活,1例死亡。局部复发率14.1%,肺转移率5.1%,骨不愈合14.1%,关节不稳定9%,内固定折断、感染率及骨折均为6.4%。治疗满意率83.2%,最终保肢率98.7%。结论采用深低温保存异体骨进行骨巨细胞瘤切除后骨缺损的修复重建是一种有效方法;同时,异体骨移植也是一种有较高并发症发生率的重建方法,降低并发症可提高肢体功能;肿瘤复发是影响治疗满意率的主要影响因素,恰当的外科边界是治疗骨巨细胞瘤的关键。
Objective To evaluate the functional outcome and the complications of allograft replacement in management of giant cell tumors of bone. Methods Seventy-seven patients who underwent bone tumor resection and massive allograft reconstruction of bone defects between 1992 and 2002 were evaluated. The length of the resected part ranged from 5 to 11 centimeters. Fresh-frozen allografts were employed as osteoarticular grafts （ n = 47 ） , hemi-condylar （ n = 12 ） , massive （ n = 14 ） or allograftprosthesis composite （ n = 4）. Most of the lesions located in proximal and distal femur, proximal tibia and humerus. The oncological parameters that were evaluated including survival of the patient, local recurrence, and metastasis. The radiographic parameters included time to union, stability of the joint, fracture of the allograft. Mankin evaluation system was used to assess functional outcome. Results At a median of 35 months （range from 12 to 135 months） after the operation, 76 of the patients in the study group were free of disease, and one had died of disease. Eleven （ 14. 1% ） patients had local recurrence and 12 （ 15.4% ） nonunion. Late complications included 5 （ 6.4% ） fractures of the allograft and 5 （ 6.4% ） infections of the graft. Instability of the joint in the form of subluxation was noted in 5 （ 6. 4% ） patients. One extremity were amputated due to local recurrence. On the basis of Mankin functional evaluation, the total satisfied rate was 83.2 percent. Osteoarticular graft got the highest score （91.5%） and hemi-condylar got the lowest （66.6%）. Massive grafts and composite were at the middle （ranges from 71.4% to 75%）.Conclusion Allografts offer many types of reconstruction for bony defects after tumor resection. The functional results are comparable to other methods of reconstruction, and once incorporated by the host, offer the advantage of longevity. It is also a method with high complication, and decreasing the complications could improve the functional score. Less resection could get better reconstruction and better function, less margin resulted at the same time. The risk of recurrence increases when less surgical margin achieves. The main end-result-influencin~ factor is local recurrence.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2005年第16期1058-1062,共5页
Chinese Journal of Surgery
关键词
肢体功能
骨缺损
临床报告
冷冻异体骨移植
骨巨细胞瘤
治疗
Giant cell tumor of bone
Bone transplantation
Transplantation, homologous
Orthopedic procedures
