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Abstract:

Objective To investigate the clinical effects and complications of massive allograft boneconstruction in malignant tumor. Methods Retrospective analysis was conducted on eligible bone tumorpatients treated in the Affiliated Tumor Hospital of Zhengzhou University from 2007 to 2018. The study includedgeneral information of patients，primary disease，surgical site，length of reconstructed allograft bone，methods ofinternal fixation, postoperative graft healing，complications of internal fixation，and the ultimate survival statusof the graft. Results A total of 37 patients were included in the study，including 21 males，an average age of22.41（9 ～ 53）years. The incidence sites included 11 of proximal humerus，3 of radius and ulna，12 of femur，8 ofproximal tibia，and 3 of pelvis. Primary tumors included osteosarcoma in 25，giant cell tumor in 5，Ewing's sarcoma in 4，chondrosarcoma in 2，and other 1 patient. The operation methods were intercalary bone grafting in 17 and osteoarticular grafting in 20 patients. Internal fixation mainly included limited contact plates（LCP）or intramedullary nails. The operation time was（180 ～ 360）min，and the blood loss was（400 ～ 2600）ml. Postoperative wound complications included superficial infection in 2 patients，rejection reaction and sinus tract formation in 1 patient，and joint stiffness in 5 patients. Postoperative allograft bone healing without any additional intervention happened in 20 patients（54.05%），with the healing time of 6 ～ 24 months. Problems of bone healing appeared in 17 patients （45.95%）and 22 cases. The complications included nonunion（21.62%），graft resorption（including shaft andhumerus head，27.03%），and graft refracture（16.22%）. Postoperative limb function and joint range of motion can be competent for the patient's daily activities，6 cases（16.20%）of patients had tumor metastasis after surgery，and 7 cases（18.90%）had local recurrence. The 5-year survival rate was about 65% after surgery，and the tumor recurrence and metastasis were correlated with the bone graft pattern. Conclusion Homologous large segment allograft plays a certain role in bone tumor resected operation，which can achieve the purpose of bone reconstruction and bone union. But it has a high incidence of middle-long term complications，such as bone nonunion，boneresorption and postoperative re-fracture. It is recommended that the allograft bone should be protected by rigid with sufficient length of internal fixations. Removed of the internal fixations was not recommended after surgery.

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