带血管腓骨复合异体骨修复长骨肿瘤切除后骨缺损  

The combination of a vascularized fibula with a massive allograft for reconstruction after intercalary resection of long bone tumor in extremities

作　　者：李靖[1] 王臻[1] 郭征[1] 栗向东[1] 范宏斌[1] 付军[1] 吴智刚[1] 陈国景[1] 

机构地区：[1]第四军医大学西京医院骨肿瘤科,西安710032

出　　处：《中华骨科杂志》2011年第6期605-610,共6页Chinese Journal of Orthopaedics

摘　　要：目的探讨带血管腓骨复合异体骨重建长骨恶性肿瘤切除后骨缺损的临床结果。方法2006年4月至2009年10月对19例四肢长骨恶性骨肿瘤患者行保肢手术，男11例，女8例；年龄11～37岁，平均（18．5±7．6）岁。肱骨5例、股骨7例、胫骨7例。肿瘤切除后骨缺损长度（13．2±4．3）cm，采用带血管自体腓骨复合大段异体骨进行重建。16例采用游离腓骨与异体骨复合，3例胫骨缺损采用同侧带血管蒂腓骨局部转移与异体骨复合。术后对移植腓骨的成活与骨结合部愈合情况进行影像学评估，采用1993年美国骨肿瘤学会功能评分对术后功能进行评估。结果全部病例随访11-46个月，平均27．5个月。移植腓骨长度平均（17．9±5．2）cm。骨扫描结果证实移植腓骨均成活，异体骨和宿主骨的平均愈合时问为胫骨（14．1±3．3）个月、股骨（11．3±2．8）个月、肱骨（6．8±1．4）个月。终末随访时上肢功能评分平均为95．2％，下肢平均为91．8％。14例随访2年以上，11例无复发转移，1例复发切除后无瘤生存，1例带瘤生存，1例死于肺转移。结论带血管自体腓骨复合大段异体骨可用于四肢长骨恶性肿瘤切除后骨缺损的重建，带血管腓骨促进了异体骨与宿主骨愈合，术后重建功能良好。Objective To investigate the effects of combined use of an allograft and vascularized fibular flap for the reconstruction of bone defects after intercalary resection of long bone malignancy. Meth- ods From April 2006 to October 2009, 19 patients that had intercalary resection of long bone malignancy （5 in humerus, 7 in femur, 7 in tibia） underwent reconstruction with an allograft and vascularized fibula construct, including 11 males and 8 females with an average age of 18.5 years. The average length of the defect was 13.2±4.3 cm. Free vascularized fibula flaps were used in 16 patients and ipsilateral pedicle vascularized fibula grafts in 3. Time to union was recorded through evaluation of plain radiographs. Bone scan was used to evaluate the viability of the vascularized fibula. Patients were examined oncologically and radiographically and were assessed functionally with MSTS-93. Results The mean follow-up time was 27.5 months. The average length of the fibula flap was 17.9±5.2 cm. Viability of the fibular grafts was verified in all cases. The average time for bone union at allograft-host junction was 11.3±2.8 months in femur, 14.1±3.3 in tibia, 6.8± 1.4 in humerus, respectively. The MSTS-93 average score at final follow-up was 95.2% in upper extremity and 91.8% in lower extremity. The oncology result in patients with follow-up more than 2 years was continuous disease free in 11 patients, no evidence of disease after recurrence following resection in 1, alive with tumor in 1, and died of lung metastasis in 1. Conclusion Vascularized fibular flap in combination with massive allograft provide an option for reconstruction of large bony defects after long bone malignancy extirpation. The viability of the fibula is a cornerstone in success of reconstruction that prevents allograft nonunion and result in decreased time to bone healing, leading to earlier patient＇s recovery of function.

关 键 词：腓骨 骨移植 移植 同种 骨肿瘤 四肢 

分 类 号：R687.3[医药卫生—骨科学]