胫骨远端恶性肿瘤瘤段切除大段异体骨移植术后临床效果分析  

Analysis of clinical results of large allogeneic bone transplantation for malignant tumor wide resection of distal tibia

作　　者：董扬[1] 杜鑫辉[1] 

机构地区：[1]上海市第六人民医院,200233

出　　处：《中国骨肿瘤骨病》2011年第6期554-557,共4页Chinse Journal Of Bone Tumor And Bone Disease

摘　　要：目的探讨大段异体骨移植在胫骨远端骨肿瘤保肢手术后的临床效果。方法自2004年6月至2009年6月我院骨肿瘤科共收治了15例进行大段异体骨移植的胫骨远端恶性骨肿瘤患者。其中骨肉瘤3例,软骨肉瘤4例,恶性纤维组织细胞瘤4例,恶性骨巨细胞瘤2例,造釉细胞瘤2例。其中15例患者均进行了瘤段切除大段异体骨移植,并进行了髓内钉内固定和踝关节融合。术后每月复查平片。患肢功能应用MSTS评分系统评价。结果 15例患者均获得随访,随访时间12-72个月。至最近1次随访,所有患者异体骨与自体骨均得到骨性愈合。主要并发症:骨不连及排异反应,各1例。骨不连经再次手术植骨后愈合,排异反应患者经切口换药2个月后切口愈合。15例患者随访过程中无1例出现病理性骨折及感染,肿瘤复发等情况。平均MSTS评分为85%。结论我们认为大段同种异体骨修复胫骨远端肿瘤术后骨缺损是一种切实可行的有效方法 。Objective To investigate the clinical results ot large allogenelc oone transplantanon attex umusalvage surgery of bone tumors of distal tibia. Methods From June 2004 to June 2009, 15 patients with malignant tumors of distal tibia were treated in the department of orthopaedic oncology of our hospital with large allogeneic bone transplantation. Of all the 15 patients, 3 cases were of osteosarcoma, 4 cases of chondrosarcoma, 4 cases of malignant fibrous histocytoma, 2 cases of malignant giant cell tumor and 2 cases of adamantinoma. Intramedullary nail fixation and ankle arthrodesis were performed for all patients. Plain radiographs were reexamined postoperatively each month. The function of the affected limb was evaluated with MSTS grading system. Results All the patients were followed up for 12-72 months. Till the last follow-up, bone union of allograft and autogenous bone was achieved for all patients, while the main complications were bone nonunion and rejection reaction, each in 1 patient. The patient achieved bone union after another operation and the wound of the patient with rejection reaction healed 2 months after the operation with changing dressings. No pathological fracture, wound infection, tumor recurrence and so on of all the 15 patients was detected till the last follow-up. According to the MSTS grading system, the mean score was 85%. Conclusions Large allogeneic bone repair for bone defect after tumor surgery of distal tibia can be regarded as a practical and effective method.

关 键 词：大段异体骨 胫骨远端骨缺损 恶性肿瘤 重建 

分 类 号：R738.1[医药卫生—肿瘤]