■骨肿瘤切除后重建骨干缺损的选择包括生物或假体植入物。我们研究的目的是评估不同类型的层间重建技术,包括大量同种异体骨移植,体外失活自体移植,血管化的游离腓骨,和模块化假体。
■我们对使用“骨干骨肿瘤和颅间重建”术语的文章进行了系统综述。所有报告非肿瘤并发症的研究,如感染,包括不愈合和层间重建的骨折。我们排除了2000年之前发表的文章,或者没有涉及人类的研究。病例报告,reviews,根据摘要,技术笔记和观点文章也被排除在外。然后研究了这篇综述中包含的33篇文章,以评估故障率,不同手术间重建技术的并发症和功能结局。
■同种异体移植的骨不连发生率为6%-43%,模块式假体无菌性松动率0%~33%。同种异体移植和血管化腓骨移植的骨不愈合率分别为6%-43%和0%-33%,分别。同种异体移植物和同种异体血管化腓骨移植物的骨折率分别为7%-45%和0%-44%,分别。同种异体移植物和同种异体血管化腓骨移植物的感染率为0%-28%和0%-17%,分别。所有同种异体移植物(范围:67%-92%),包括辐照在内的体外离体自体移植物(87%),高压灭菌(70%),巴氏灭菌(88%),低热(90%)或用液氮冷冻(90%),和模块化假体(范围:77%-93%)具有相似的肌肉骨骼肿瘤学会功能评分。将血管化腓骨移植物添加到同种异体移植物并不影响功能结果[具有血管化腓骨移植物的同种异体移植物(范围:86%-94%)与单独移植(范围:67%-92%)]。
■模块化假体的无菌性松动率似乎低于同种异体移植的骨不愈合率。将血管化腓骨移植物添加到同种异体移植物似乎可以增加骨愈合率并降低骨折和感染的风险。尽管血管化腓骨移植物需要更长的手术时间,并且具有供体部位发病率的缺点。这些有或没有血管化腓骨自体移植的各种cal间重建技术具有相似的功能结果。
UNASSIGNED: The options for the reconstruction of diaphyseal defects following the resection of bone tumors include biological or prosthetic implants. The purpose of our study was to evaluate different types of intercalary reconstruction techniques, including massive bone allograft, extracorporeal devitalized autograft, vascularized free fibula, and modular prosthesis.
UNASSIGNED: We performed a systematic review of articles using the terms diaphyseal bone tumor and intercalary reconstruction. All the studies reporting the non-oncological complications such as infection, nonunion and fracture of the intercalary reconstructions were included. We excluded articles published before 2000 or did not involve humans in the study. Case reports, reviews, technique notes and opinion articles were also excluded based on the abstracts. Thirty-three articles included in this review were then studied to evaluate failure rates, complications and functional outcome of different surgical intercalary reconstruction techniques.
UNASSIGNED: Nonunion rates of allograft ranged 6%-43%, while aseptic loosening rates of modular prosthesis ranged 0%-33%. Nonunion rates of allograft alone and allograft with a vascularized fibula graft ranged 6%-43% and 0%-33%, respectively. Fracture rates of allograft alone and allograft with a vascularized fibula graft ranged 7%-45% and 0%-44%, respectively. Infection rates of allograft alone and allograft with a vascularized fibula graft ranged 0%-28% and 0%-17%, respectively. All of the allograft (range: 67%-92%), extracorporeal devitalized autograft including irradiation (87%), autoclaving (70%), pasteurization (88%), low-heat (90%) or freezing with liquid nitrogen (90%), and modular prosthesis (range: 77%-93%) had similar Musculoskeletal Tumor Society functional scores. Addition of a vascularized fibula graft to allograft did not affect functional outcome [allograft with a vascularized fibula graft (range: 86%-94%) vs. allograft alone (range: 67%-92%)].
UNASSIGNED: Aseptic loosening rates of modular prosthesis seem to be less than nonunion rates of allograft. Adding a vascularized fibula graft to allograft seems to increase bone union rate and reduce the risk of fractures and infections, though a vascularized fibula graft needs longer surgical time and has the disadvantage of donor site morbidity. These various intercalary reconstruction techniques with or without a vascularized fibula autograft had similar functional outcome.