异体骨移植治疗骨肿瘤  

Massive Allograft Implantation for Defects After Bone Tumor Resections

作　　者：牛晓辉[1] 徐万鹏[1] 郝林[1] 蔡尤伯[1] 杨荣利[1] 

机构地区：[1]北京积水潭医院骨肿瘤科

出　　处：《中华骨科杂志》1997年第2期87-91,共5页Chinese Journal of Orthopaedics

摘　　要：作者统计了３５年中应用大块异体骨移植的方法治疗骨肿瘤外科手术切除后遗留的大范围缺损１２３例，并对其中资料齐全的６４例（包括１／２，１／４关节，全髋及骨盆大块异体骨植入）病人从疾病种类、发病部位、是否化疗与术后并发症和预后关系方面进行了阐述。该组６４例病人中，平均年龄２９．１岁（１９～４９岁）。疾病种类以骨巨细胞瘤和骨肉瘤为主。手术切除范围以Ｅｎｎｅｋｉｎｇ分期标准为原则。发病部位主要是股骨下端和胫骨上端，其余有肱骨上端、股骨上端、胫骨下端、骨盆和骶骨。异体骨的处理均为化学制剂保存方法。固定应用钢板，螺丝钉，髓内针等内固定物；半关节异体骨长度为８～２５ｃｍ不等。平均随访时间为３６．５个月。作者用Ｍａｎｋｉｎ提出的评定标准，将愈后结果分为优、良、中、差四级，差为不满意。并发症包括无复发的骨不愈合、异体骨骨折、感染和可以局部治愈的复发及不能局部治愈的复发。结果：本组病人治疗满意率为５４．７％，并发症发生率为６２．５％，最终保肢率为７０．３％。异体骨做为肿瘤切除后大块骨缺损的替代物较其他方法有形态合适、有软组织附着点、愈合后终生使用等诸多优点。移植骨的体积大小、受骨区软组织条件好坏，肿瘤的恶性程度均影响并发症的发生?From 1959 to 1991, 96 resections and allograft implantations were performed for the management of tumorous bone conditions. All of these 96 grafts were alcohol preserved. 64 patients were followed up for fourteen or more months, satisfactory rate was achieved in 54.7%.The results were better in patients with 1/4 joint transplantation or without chemotherapy. Complications and recurrences were the major factors in determining outcome, main complications were infection, nonunion and fracture of grafts. With further surgical management, some of the patients with complications or recurrences preserved their limbs. The final limb preservation rate was 70.3%.

关 键 词：异体移植 骨移植 骨肿瘤 骨缺损 

分 类 号：R738.105[医药卫生—肿瘤] R683.05[医药卫生—临床医学]