Segmental Allograft and Extracorporeally Irradiated Autograft Reconstruction After Intercalary Resection of Malignant Bone Tumors

27 patients who underwent intercalary resection for malignant tumors between 1993 and 2001 were reviewed. 21 had a high-grade osteosarcoma (20 stage IIB, 1 stage III), two a chondrosarcoma, two a malignant fibrous histiocytoma, one a leiomyosarcoma, and one a solitary plasmacytoma chondrosarcoma. The average length of the resected bone was 16.9 cm (10.3 to 26.1). Of these 27 patients, 13 received segmental allograft reconstuction and 14 were treated with extracorporeally irradiated autograft. 19 tumors were located in the femur, 5 in the tibia, and 3 in the humerus. Eight grafts were fixed with plates, four with intramedullary nails, and the remaining 15 with intramedullary nails combining with one or two plates at the sites of osteosynthesis. All patients, except the two with chondrosarcoma, received chemotherapy. At a mean follow-up of 68 months (24 to 126), 18 (67%) of the patients were free of disease, five (18%) had died of disease, and four (15%) were alive with lung metastases (15%). Two patients (7%), one with an allograft and one with an irradiated autograft, had a local recurrence, and underwent an amputation subsequently. Two (14%) of the 14 extracorporeally irradiated autografts and one (8%) of the 13 segmental allografts fractured (p = 0.404). Nonunion occurred in one of 14 (7%) irradiated autografts compared with five of 13 (38%) segmental allografts (p = 0.045). Five of the 19 grafts (26%) that were fixed with intramedullary nails went on to a nonunion; however, only one of the eight grafts (13%) fixed with plates had this complication (p = 0.215). After additional plating or replacing the broken nails associated with routine autogenous cancellous bone grafting, all of the nonunions healed uneventfully. None of the segmental allografts or irradiated autografts were removed. Furthermore, no patient had wound infection. Using the Enneking functional evaluation system, the mean postoperative scores for the patients without a local recurrence was 87% (80 to 96), which was similar in these two groups. In this series, 22% (6/27) nonunion rate, 11% (3/27) fracture rate, and 0% infection rate compared favorably with previous reports of intercalary allograft reconstruction. Reconstruction with an extracorporeally irradiated autograft has a significantly lower nonunion rate (7% vs. 38%) but an insignificantly higher fracture rate (14% vs. 8%) than with a segmental allograft. Extracorporeally irradiated autograft could be an acceptable alternative in the reconstruction after intercalary resection, especially in countries where it is difficult to obtain allografts.

並列關鍵字

malignant bone tumor ； intercalary resection ； extracorporeal irradiation ； segmental allograft ； autograft

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