Complications of Massive Bone Allograft Transplantation

大塊異體骨移植之併發症

王俊聞(Jun-Wen Wang) ； 施俊雄(Chun-Hsiung Shih)

《Journal of Orthopaedic Surgery Taiwan》 10卷1期 (1993/03) Pp. 47-56

摘要

本院從1982至1991年以大塊異體股骨移植治療了25個病人，包括12位男性，13位女性，平均年齡為34歲。其中22例為骨腫瘤患者，兩例為全人工髖關節置換後失敗的患者，一例為轉子下骨折術後失敗的病例。平均使用異體骨的長度為14分工。二十例在異體及宿主骨交接處加上自體骨移植，六例骨癌患者曾接受化學治療。本研究之目的在於分析大塊異體骨移植後併發症的發生及治療，並研究同時加上自體骨移植或化學治療對異體骨之影響。所有病人經平均四年的追蹤，一例死於骨癌併肺轉移，一例腫瘤復發，兩例發生腓骨神經麻痺，另外九例(36%)發生與異體骨有關之併發症，包括兩例未癒合，兩例延遲癒合，三例異體骨骨折，兩例深層感染。這些與異體骨有關的併發症，除了一例感染因病人拒絕手術外，其餘不是症狀輕微，便是經再度手術後解決。本研究亦發現同時加上自體骨移植可加速異體骨瘉合並減少未癒合率。化學治療對異體骨移植無不良影響。大塊異體骨移植的併發症並非少見，但可以較佳的手術減少其發生，即使發生併發症，大多數均能妥善解決。

並列摘要

Twenty five consecutive large segment fresh frozen allografts were implanted for tumor and nontumor conditions from 1982 to 1991.These include 12 men and 13 women with the age ranged from 14 to 77years (mean, 34 years). Twenty two patients had resection of bone tumors of which 15 were malignant and seven aggressive. Three patients had resection of proximal femur for nontumor conditions,two for failed total hip arthoplasties, one for subtrochanteric nonunion and cutout of hip compression screw. The average length of allografts was 14 cm (range, 6 to 22 cm). A supplement of autografts at allograft-host junction was performed in 20 patients.Six patients received pre-and/or postoperative chemotherapy for high grade sarcomas. At an average period of four years (range,one to nine years), one patient had died of disease, one had a tumor recurrence, two had peroneal neuropathies. There were nine allograft related complications (36%) which in-cluded two nonunions,two delayedunions, three graft fractures and two deep infections.The nonunions and delayed unions were repaired with autogenous iliac bone grafts. Three graft fractures were treated conservatively. One infedction was successfully replaced with a vascularized fibular graft. Supplement with auto-grafts significantly shortened the union time of the allograft from 15 to 8 months and reduced the nonunion rate. The adjuvant chemotherapy did not have an adverse effect on the outcome of allograft.

並列關鍵字

complications ； allograft ； autograft ； chemotherapy