四肢骨肿瘤切除后应用大段同种异体骨移植交锁髓内钉内固定修复骨缺损

四肢骨肿瘤切除后应用大段同种异体骨移植交锁髓内钉内固定
修复骨缺损
杨祚璋;许建波;詹辉;袁涛;张晋煜;钱保生;李文忠
【期刊名称】《中国组织工程研究》
【年(卷),期】2006(010)001
【摘要】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 progression of transplantation of allografts has put forward to a new way to repair massive bone and joint defect caused by various reasons, which was a difficult subject in the past.OBJECTIVE: To probe into the effect of massive allograft and interlocking intramedullary nail on rebuilding bone and joint after bone tumor resection.DESIGN: Self-control observation SETTING: Department of Orthopaedics, Yunnan Provincial Tumor Hospital PARTICIPANTS: From April 1998 to January 2003, totally 18 patients with 15 cases of malignant bone tumor and 3 of osteoma-like disease, accepted bone tumor focus removal followed by intrmedullary nailing and allogenic bone transplantation, consented to join the study, were
recruited.INTERVENTIONS: Allografts were taken from fresh cadaveric bone (Prepared and stored in Yunnan Provincial Tumor). The bone segment of osteoma was cut completely and the allografts were transplanted at the bone defects. The proximal and distal intrmedullary nailing were inserted in order. Auto cancellous bone particles were transplanted at the bone joint to promote the healing at bone end. The upper part of shoulder bone was transplanted to perform reconstruct of retotar and triangular muscle; half knee joint was transplanted to attach important muscle and ligament. After external fixation of 4 to 6 weeks following operation, the functional exercise was conducted in order sequence. Evaluating the curative effect of functional recovery of the limbs
at postoperative 3,6 and 12 months as well as follow-up was carried out according to the criteria of Mankin(excellent ,good , moderate , unsatisfied).MAIN OUTCOME MEASURES: ①Functional recovery of limb of the patients. ② Adverse and side effectRESULTS: Date of totally 18 patients was entered result analysi s. ①Functional recovery result of the limbs: According to evaluated criteria put forward by Mankin. In this group, 7 cases of excellent, 6 of good, 4 of moderate and 1 of unsatisfied. Bony callus and the concentration of nuclide were increased gradually in the examination at month 6 and 12. About 10-14 months after operation, the osteotylus would cover the end of allograft, substituted the allograft gradually. ② Adverse events and side effect:In this group, no tumor was survived in 16 cases, two cases died of primary lesion and pulmonary metastasis at postoperative 12 months and 18 months respectively. No infection, bone nonunion, flexible internal fixation or ruptures were found in the limbs of other patients. No one was found with shortened limbs. The patient with part joint transplantation has limitation in joint move, but the joint was stable.CONCLUSION: This operation has the highest stabilization .The patients can do exercise earlier to recover function, and injury arthritis could be prevented. It is suitable to rebuild the bone after bone tumor resection.
【总页数】3页(P183-185)
【作者】杨祚璋;许建波;詹辉;袁涛;张晋煜;钱保生;李文忠
【作者单位】昆明医学院第三附属医院,云南省肿瘤医院骨科,云南省,昆明
市,650118;昆明医学院第三附属医院,云南省肿瘤医院骨科,云南省,昆明市,650118;昆明医学院第三附属医院,云南省肿瘤医院骨科,云南省,昆明市,650118;昆明医学院第三附属医院,云南省肿瘤医院骨科,云南省,昆明市,650118;昆明医学院第三附属医院,云南省肿瘤医院骨科,云南省,昆明市,650118;昆明医学院第三附属医院,云南省肿瘤医院骨科,云南省,昆明市,650118;昆明医学院第三附属医院,云南省肿瘤医院骨科,云南省,昆明市,650118
【正文语种】中文
【中图分类】R738.1
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