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目的探讨复合骨移植在下肢骨肿瘤保肢术中重建骨缺损的手术原理及效果。方法应用携带监测皮岛吻合血管的自体腓骨与深低温冷冻大段同种异体骨复合移植,重建下肢骨肿瘤切除后的长段骨缺损12例。其中,骨肉瘤6例,恶性纤维组织细胞瘤1例,骨纤维结构不良2例,骨巨细胞瘤3例。结果12例经术后8~38个月随访,1例死于肺转移,2例带瘤存活,9例无瘤存活。术后功能优良率达75%。10例术后3个月内X线示骨端骨性愈合,2例内固定失败重新外固定后骨性愈合,所有均在9个月内能完全负重行走。结论携带监测皮岛吻合血管的自体腓骨与深低温冷冻大段同种异体骨复合移植,适用于下肢骨肿瘤保肢术中的长段骨缺损的修复,具有自体活骨移植和异体骨移植的双重优点。
Objective To investigate the surgical principle and effect of composite bone graft in reconstructing bone defect in limb salvage surgery of lower extremity bone tumors. Methods 12 cases of long segmental bone defect after resection of the lower extremity bone tumor were reconstructed by autograft fibular graft and deep cryogenic frozen allograft transplantation. Among them, 6 cases of osteosarcoma, 1 case of malignant fibrous histiocytoma, fibrous dysplasia in 2 cases, 3 cases of giant cell tumor of bone. Results 12 cases were followed up from 8 to 38 months after operation. One died of lung metastasis, two survived with tumor and nine survived without tumor. Excellent postoperative function rate of 75%. In 10 cases, X-ray showed bony union within 3 months and 2 cases with internal fixation failed after external fixation. All of them were able to walk completely with weight within 9 months. CONCLUSIONS: The autograft fibular grafts with deep hypothermia frozen section and the autograft fibular grafts with sciatic vascular anastomosis are suitable for the repair of long segmental bone defects in limb salvage operations of lower extremity bone tumors. The autologous living grafts and allogenic bone grafts Double advantage.