活骨移植治疗四肢骨肿瘤切除后长段骨与关节缺损  

Repairing the large defect of bone and joint of limbs with vascularized bone graft after tumor excision

作　　者：胡勇[1] 刘玉玲[2] 尹宗生[1] 董吟林[1] 高学纯[1] 

机构地区：[1]安徽医科大学第一附属医院骨科,安徽合肥230022 [2]安徽医科大学外科总论教研室

出　　处：《中国骨伤》2006年第2期78-80,共3页China Journal of Orthopaedics and Traumatology

摘　　要：目的：探讨四肢骨肿瘤的广泛或边缘切除后，长段骨关节缺损的修复方法及其疗效。方法：四肢骨肿瘤切除术后骨缺损14例，男10例，女4例；年龄4～37岁。骨巨细胞瘤4例，骨化性纤维瘤1例，非骨化性纤维瘤2例，韧带样纤维瘤1例，骨纤维结构不良3例，侵袭性骨母细胞瘤1例，软骨母细胞瘤1例，瘤样病损致骨溶解1例。14例四肢侵袭性良性骨肿瘤行肿瘤广泛或边缘切除，应用吻合血管的腓骨、带腓骨头腓骨近端和带旋髂深血管的髂骨瓣移植修复骨缺损、重建桡腕关节和重建肩关节。移植体行简单内固定加外固定。术后定期复查X线片、多普勒血管超声，其中3例行ECT核素骨扫描，并作关节功能评定。结果：随访3个月～5年，13例均于手术后3个月后达Ⅰ期愈合，其中1例因内固定松动再次手术而愈合。1例肿瘤局部复发，再次行肿瘤切刮与植骨术后愈合；2例畸形愈合行截骨矫形后愈合。关节功能评定：优9例，良3例，差2例。结论：骨肿瘤切除后行骨移植修复骨缺损、重建关节，手术切除彻底，复发率低，植骨愈合可靠，重建后的关节功能良好。Objective：To investigate the methods and outcomes of repairing the large defect of bone and joint of limbs after resecting tumor by transplantation of vascularized bone. Methods.Forteen patients（10 male and 4 female with ages ranging from 4 to 37 years） with the large defect of bone and joint of limbs after resecting bone tumor were recruited. In the all 14 patients there were 4 cases of giant cell tumor, 1 ease of ossifying fibroma, 2 cases nonossifying fibroma, 1 case of desmoid tumor, 3 cases of osteofibrous dysplasis, 1 case of invasive osteoblastoma, 1 case of chondrobl＆stoma and 1 case of osteolysis. All patients were treated by tumor excision followed by transplantation with vascularized fibula, vascularized proximal fibula and vascularized iliac hone by anastomose and reconstruct the radioearpal and shoulder joint. After operation,all patients were evaluated by radiogram,Doppler ultrasonic wave, nuclide ECT scan and the joint function were also assessed. Results： All patients were followed-up from 3 months to 5 years. Transplanted bones of 13 patients were primarily healed in 3 months after operation. One case was undergone a re-operation because of internal fixation loosening. One patient of local recurrence was finally healed after another treatment by tumor currettement and bone grafting. Two patients of malunion were also healed by a second treatment of osteotomy. The function of joints was evaluated. The excellent result was achieved in 9 cases, good in 3 cases and poor in 2 cases. Conclusion： Repairing the large defect of bone and joint of limbs with vascularized bone graft after excision of tumor is a good therapeutic method,which is based on the facts that after the treatment above the function of joints retains well, the local recurrent rate is lower, and the bone reunions is reliable.

关 键 词：骨肿瘤 骨移植 骨缺损 四肢骨肿瘤 肿瘤切除 长段骨缺损 关节缺损 

分 类 号：R739.96[医药卫生—肿瘤]