摘要
目的探讨液氮灭活自体瘤段骨回植修复长骨骨干恶性肿瘤切除后骨缺损的中期疗效。方法回顾性分析2015年7月至2017年6月在北京积水潭医院骨肿瘤科采用液氮灭活自体瘤段骨回植修复长骨骨干恶性肿瘤切除后骨缺损的16例患者资料,男10例、女6例;年龄(23.4±11.6)岁(范围8~44岁),经典型骨肉瘤8例、骨表面高级别骨肉瘤2例、Ewing肉瘤4例、骨膜骨肉瘤和骨未分化肉瘤各1例;肿瘤位于肱骨2例、股骨8例、胫骨6例;肿瘤长度(12.4±4.8)cm(范围5.5~26 cm)。术后每6个月行影像学检查,根据国际保肢协会(International Society of Limb Salvage,ISOLS)同种异体骨移植后影像评估方法评价回植骨-宿主骨愈合情况,根据Henderson分型评价并发症情况。通过Kaplan-Meier生存曲线计算患者五年生存率及移植物生存率。结果16例患者中3例因多发转移分别于术后19、20和33个月死亡,另13例随访期末均无瘤生存,随访时间为64(60.3,69.8)个月。16例患者32个截骨端,其中30个愈合,包括干骺端截骨11个,瘤段经液氮灭活自体骨回植后愈合时间为9(6,12)个月;骨干截骨端19个,愈合时间为13(9,21)个月,不同部位愈合时间的差异有统计学意义(Z=-2.25,P=0.025)。16例患者中,骨干截骨端未愈合2例次、因不愈合而致内固定失效1例次、复发3例次,无一例发生软组织并发症及感染。1例内固定失效患者使用带血管蒂髂骨移植,术后6个月截骨端愈合;1例多发转移患者死亡时仍有1个截骨端未愈合。3例复发均位于液氮灭活自体瘤段骨外软组织,其中1例再次手术切除并行局部放疗,术后65个月仍无瘤生存;2例因多发转移而死亡。Kaplan-Meier生存曲线计算患者五年生存率为81%,移植物生存率为100%。无一例截肢,保肢率为100%。结论采用液氮灭活自体瘤段骨回植重建骨干恶性肿瘤切除后骨缺损的愈合率高、干骺端骨愈合时间较骨干截骨端愈合时间更短�
Objective To explore the mid-term efficacy of liquid nitrogen-inactivated autologous tumor segment bone replantation for repairing bone defects after resection of malignant tumors in the long bone shaft.Methods A retrospective analysis was performed on the clinical data of 16 patients treated with liquid nitrogen-inactivated autologous bone graft at Beijing Jishuitan Hospital from July 2015 to June 2017 to repair defects caused by malignant tumour resection of the diaphysis.There were 10 males and 6 females with a mean age of 23.4±11.6 years(range,8-44 years),including 8 classic osteosarcoma,2 high-grade surface osteosarcoma,4 Ewing's sarcoma,1 periosteal osteosarcoma,and 1 undifferentiated pleomorphic sarcoma.Tumors were located in the humerus in 2 cases,in the femur in 8 cases and in the tibia in 6 cases.The mean length of tumor was 12.4±4.8 cm(range,5.5-26 cm).Postoperative imaging examination was performed every 6 months,and the healing status of the transplanted bone-host bone was evaluated based on the imaging assessment method of the International Society of Limb Salvage(ISOLS)imaging assessment after allogeneic bone transplantation,and the complications were assessed using the Henderson classification.The five-year survival rate for patients and grafted bone was calculated using the Kaplan-Meier survival curve.Results The median follow-up was 64(60.3,69.8)months.At the end of follow-up,13 patients were tumour free and 3 patients died of multiple metastases at 19,20 and 33 months after surgery.There were 32 osteotomy ends in 16 patients,of which 30 healed,including 11 metaphyseal osteotomy ends,and the healing time was 9(6,12)months after replantation of the tumour segment with liquid nitrogen-inactivated autologous bone;19 osteotomy ends in the diaphysis took 13(9,21)months to heal,with a statistically significant difference in healing time between different sites(Z=-2.25,P=0.025).Sixteen patients had six complications,including two cases of non-union at the diaphyseal site,one case of failure of intern
作者
李远
徐海荣
单华超
黄真
鱼锋
杨勇昆
刘巍峰
杨发军
牛晓辉
Li Yuan;Xu Hairong;Shan Huachao;Huang Zhen;Yu Feng;Yang Yongkun;Liu Weifeng;Yang Fajun;Niu Xiaohui
出处
《中华骨科杂志》
CAS
CSCD
北大核心
2023年第10期613-619,共7页
Chinese Journal of Orthopaedics
关键词
骨干
骨肉瘤
骨重建
移植
自体
移植
同种
Diaphyses
Osteosarcoma
Bone remodeling
Transplantation,autologous
Transplantation,homologous
