摘要
目的 分析肢体恶性肿瘤患者接受异体骨关节移植修复重建大段骨缺损的术后并发症并探讨其处理方法。 方法 因肢体恶性骨肿瘤行瘤段切除 ,采用不同内固定方式进行异体骨 关节移植术并有完整随访资料的患者 10 6例 ,随访时间 10～ 112个月 ,平均 32 3个月。术后最终结果按Mankin′s标准评价。 结果 与深低温冷冻异体骨相比 ,酒精浸泡异体骨移植更易发生感染、骨不连等并发症 ;异体骨段移植或复合人工关节移植优于半关节移植 ;深低温冷冻异体骨移植的主要术后并发症的发生率 :深部感染 10 %、肿瘤局部复发 14 4%、皮肤坏死 12 2 %、骨延迟愈合或骨不连 15 6 %。术后总评优良率 73 7% ,去除肿瘤复发因素 ,优良率为 82 2 % ;动力型内锁髓内钉优于普通髓内钉和加压钢板。 结论 准确判定肿瘤安全边缘 ,坚强髓内固定 ,良好的软组织覆盖和重建可减少术后并发症的发生。
Objective [WT5”BZ]To analyze the postoperative complications of bone and joint allografting for the reconstruction of massive bone defect after the resection of malignant bone tumors and its management. [WT5”HZ]Methods [WT5”BZ]Bone joint allografting for the reconstruction of massive bone defect after the resection of malignant bone tumors with different internal fixations was performed in 106 patients with complete follow up data. Bone healing time, complication rate, and final results in different allografts were compared. Operation indications, complications and internal fixation were also analyzed. The final results were determined according to the Mankin′s standard. [WT5”HZ]Results [WT5”BZ]Alcohol marinates allografts were more susceptible to infection, non union, etc. Allografts and combined prosthesis were superior to semi articular transplantation. Complications included deep infection (10%), skin necrosis (12 2%),local recurrence (14 4%), and delayed union or non union (15 6%). Dynamic interlocked intramedullar nailing was superior to conventional intramedullar nailing and compression plates. [WT5”HZ]Conclusions [WT5”BZ]Allografting is acceptable for the reconstruction of massive bone defect after tumor resection. Its results are encouraging after proper management of complications caused by surgical technique, interanl fixation and soft tissue repair. [WT5”HZ]
出处
《中华外科杂志》
CAS
CSCD
北大核心
2000年第5期332-335,I023,共5页
Chinese Journal of Surgery
