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首页> 外文期刊>Journal of Surgical Oncology >The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy.
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The use of allograft shell with intramedullary vascularized fibula graft for intercalary reconstruction after diaphyseal resection for lower extremity bony malignancy.

机译：同种异体移植壳与髓内血管化腓骨移植在下颌骨切除术治疗下肢骨恶性肿瘤后进行inter间重建。

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BACKGROUND: Reconstruction after excision of the femur and tibia malignancy is a challenging issue for the reconstructive surgeon. The combined use of a vascularized fibular flap and allograft can provide a reliable reconstructive option. This article describes the authors' experience with this technique for the treatment of large-segmental bone defects after intercalary resection of lower extremity malignancy. METHODS: From 2003 to 2008, 11 patients that had intercalary resection of lower extremity malignancy underwent reconstruction with an allograft and vascularized fibular construct. Time to union was recorded through evaluation of plain radiographs. Patients were examined clinically and radiographically and were assessed functionally with MSTS score. RESULT: The average age at time of operation was 18.5 years. The mean follow-up time was 34.1 months. The oncology result was continuous disease free in 7 patients, no evidence of disease in 2, alive with disease in 1, and died of disease in 1. Free vascularized fibula flap was used in 7 patients and ispilateral pedicle vascularized fibula in 4. The average length of the resected segment was 12.1 cm and that of the fibula flap was 16.2 cm. The primary unions were achieved in all patients except one with tibia reconstruction. The average time for bone union was 5.4 months at fibula-host junction and 11.8 months at allograft-host junction. There were no allograft fractures and no infections. Five patients had 7 local complications. The MSTS average score was 91.8% at final follow-up. The mean time of weight-bearing was 12.4 months. CONCLUSIONS: Intramedullary fibular flap in combination with massive allografts provide an excellent option for reconstruction of large-bony defects after lower extremity malignancy extirpation. The viability of the fibula is a cornerstone in success of reconstruction that prevents allograft nonunion and result in decreased time to bone healing, leading to earlier patient recovery and return of function.
机译：背景：股骨和胫骨恶性肿瘤切除后的重建对于重建外科医师而言是一个具有挑战性的问题。带血管的腓骨皮瓣和同种异体移植的组合使用可以提供可靠的重建选择。本文介绍作者使用这种技术治疗下肢恶性肿瘤inter行切除术后大段骨缺损的经验。方法：2003年至2008年，对11例下肢恶性肿瘤进行inter行切除的患者，采用同种异体移植和血管化腓骨结构进行了重建。结合时间是通过对平片的评估来记录的。对患者进行了临床和影像学检查，并通过MSTS评分对功能进行了评估。结果：手术时的平均年龄为18.5岁。平均随访时间为34.1个月。肿瘤学结果为7例连续无疾病，2例无疾病迹象，1例死于疾病，1例死于疾病。7例使用游离血管化腓骨皮瓣，4例使用同侧蒂蒂血管化腓骨。切除段的长度为12.1cm，腓骨瓣的长度为16.2cm。除一名胫骨重建患者外，所有患者均实现了初级结合。腓骨-宿主交界处平均骨接合时间为5.4个月，同种异体-宿主交界处平均为11.8个月。没有异体移植骨折，也没有感染。 5例患者有7例局部并发症。在最后的随访中，MSTS的平均分数为91.8％。平均负重时间为12.4个月。结论：髓内腓骨皮瓣联合大面积同种异体移植为下肢恶性肿瘤摘除术后重建大骨缺损提供了极好的选择。腓骨的生存能力是重建成功的基石，可以防止同种异体骨不愈合并缩短骨愈合时间，从而使患者早日康复并恢复功能。

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