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背景:近年来同种异体骨移植技术的发展为各种原因造成的大段骨关节缺损的修复这一难题提供了新的解决方法。目的:探讨四肢骨肿瘤切除后采用大段异体骨移植交锁髓内钉内固定修复骨缺损的疗效。设计:自身前后对照观察。单位:云南省肿瘤医院骨科。对象:选择1998-04/2003-02云南省肿瘤医院骨科进行的骨肿瘤病灶清除、交锁髓内钉内固定加同种异体骨移植术的患者18例(患者均签署知情同意书)。其中恶性骨肿瘤15例,瘤样病损3例。干预:同种异体骨处理来源于新鲜尸体骨(由云南省肿瘤医院制备、保存)。完整切除肿瘤骨段后,于骨缺损处植入同种异体骨,依次置入远端及近端锁钉,骨接合部植入自体松质骨粒促进骨端愈合,肱骨上端半关节移植,主要行肩袖及三角肌重建;膝关节半关节移植,应重新附丽重要肌肉、韧带。术后外固定4～6周,循序渐进功能锻炼。于术后3,6,12个月及随访时进行疗效评定。术后肢体功能恢复按Mankin评定标准评估(分为优,良,中,差)。主要观察指标:①患者肢体功能恢复结果。②不良事件和副反应。结果:18例患者,平均随访32个月,均进入结果分析。①患者肢体功能恢复结果:根据Mankin提出的评定标准,本组优7例,良6例,中4例,差1例。6和12个月检查见骨痂和核素浓集逐渐增多,10～14个月生长骨痂可覆盖骨端,并随时间的延长逐渐完成替代爬行。②不良事件和副反应:本组患者中无瘤存活16例,2例分别于术后12个月和18个月死于原发病变和肺转移。其余患者患肢均无感染、骨不连接、内固定松动或断裂。无一例肢体短缩。半关节移植者关节活动稍受限,关节稳定。结论:此手术方法使固定节段具有高度的内在稳定性,可早期进行功能锻炼,防止影响肩、膝等关节的负重功能,适合于四肢骨肿瘤切除后骨缺损的修复。
BACKGROUND: In recent years, the development of allogeneic bone transplantation has provided a new solution to the problem of repairing large bone and joint defects caused by various causes. Objective: To investigate the curative effect of large bone allograft interlocking intramedullary nailing to repair bone defects after excision of limb bone tumors. Design: control before and after their own observation. Unit: Department of Orthopedics, Yunnan Cancer Hospital. PARTICIPANTS: Eighteen patients (all patients signed informed consent) who undergone bone tumor debridement and interlocking intramedullary nailing and allograft bone transplantation in Department of Orthopedics, Yunnan Cancer Hospital from April to February 2003 were selected. Including 15 cases of malignant bone tumors, tumor-like lesions in 3 cases. Intervention: Allogenic bone treatment comes from fresh cadaveric bone (prepared by Yunnan Cancer Hospital, preserved). After complete resection of the tumor bone segment, the allogeneic bone is implanted into the bone defect, followed by the distal and proximal locking screws. The bone junction is implanted with autologous cancellous bone particles to promote the healing of the bone ends, the hemiarthroplasty of the upper humerus, The main line of rotator cuffs and deltoid reconstruction; knee joint transplantation, should re-attached Li important muscles, ligaments. External fixation after 4 to 6 weeks, step by step functional exercise. The curative effect was evaluated at 3, 6, 12 months after operation and at follow-up. Postoperative functional recovery according to Mankin assessment criteria (divided into excellent, good, medium and poor). MAIN OUTCOME MEASURES: ①Results of limb functional recovery in patients. ② adverse events and side effects. Results: Eighteen patients were followed up for an average of 32 months and were included in the result analysis. ① patient limb functional recovery results: According to Mankin’s evaluation criteria, the group of excellent in 7 cases, good in 6 cases, 4 cases, poor in 1 case. At 6 and 12 months, the callus and nuclide concentrations gradually increased. The calluses that grew 10 to 14 months could cover the bone ends and gradually replaced and crawled over time. ② adverse events and side effects: 16 patients survived in this group, 2 patients died of primary lesion and lung metastasis at 12 months and 18 months after operation respectively. The remaining patients had no infection of limbs, the bone is not connected, internal fixation loose or broken. No one limb shortening. Half-joint transplant slightly limited joint activity, joint stability. CONCLUSIONS: This procedure has high intrinsic stability of the fixed segment, early functional exercise, to prevent the impact of shoulders, knees and other joints of the load-bearing function, suitable for the repair of bone defects after removal of limb bone tumors.