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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摘要：

目的 探讨大段同种异体骨在恶性骨肿瘤切除重建术中的远期效果及并发症。方法 回顾性分析 2007—2018 年郑州大学附属肿瘤医院诊疗的符合条件的骨肿瘤患者的临床资料。研究内容包括患者一般信息、原发疾病、手术部位、重建异体骨长度、内固定方式、术后移植骨愈合情况、并发症、移植骨的最终存活状态。结果 共 37 例患者纳入研究范围，其中男性 21 例，患者平均年龄为 22.41（9 ～ 53）岁。发病部位包括肱骨近端 11 例，尺桡骨 3 例，股骨 12 例，胫骨近端 8 例，骨盆 3 例。原发肿瘤包括骨肉瘤 25 例，骨巨细胞瘤 5 例，尤文肉瘤 4 例，软骨肉瘤 2 例，其他 1 例。手术采用段间植骨 17 例，骨关节移植 20 例，内固定方式主要包括钢板或髓内钉。手术时间为（180 ～ 360）min，出血量为（400 ～ 2600）ml。术后伤口并发症有切口浅表感染 2 例，排斥反应及窦道形成 1 例，关节僵硬 5 例。术后异体骨一期愈合 20 例（54.05%），愈合时间（6 ～ 24）个月。17 例患者发生移植骨并发症（45.95%），共 22 例次。常见的并发症有骨不连（21.62%）、移植骨吸收（含骨干和肱骨头，27.03%）和移植骨再骨折（16.22%）。术后肢体功能和关节活动度可以满足患者的日常活动。术后患者发生肿瘤转移6例（16.20%），局部复发7例（18.90%）。术后 5 年生存率约为 65%，肿瘤复发与转移与移植骨方式存在相关性。结论 同种大段异体骨移植在骨肿瘤切除重建术中有一定作用，可以达到骨重建和一期愈合的目的，但存在较高的中远期并发症发生率，如骨不连、移植骨吸收和术后再骨折等。临床建议术中内固定应牢固、对异体骨的保护应充分，术后尽可能不去除内固定。

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