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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：异种移植壳与髓内血管化腓骨移植移植物，用于下肢骨痛后椎间膜切除术后骨膜切除术。

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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：切除股骨和胫骨恶性肿瘤后重建是重建外科医生的挑战性问题。血管化腓骨瓣和同种异体移植的组合使用可以提供可靠的重建选择。本文介绍了作者对这种技术的经验，用于治疗闭合性骨缺损后下肢恶性肿瘤。方法：2003年至2008年，11名患者对下肢恶性肿瘤的Intercalary切除术后与同种异体移植和血管化腓骨构建体进行了重建。通过对普通射线照相评估来记录联盟的时间。临床和射线照相检查患者，并通过MSTS得分在功能上进行评估。结果：运作时的平均年龄为18.5岁。平均随访时间为34.1个月。肿瘤学结果是7名患者的持续疾病，没有2例疾病的证据，在1中与疾病活着，并死于疾病。7例患者中使用了7例，患者血管缺陷4.平均值切除的段的长度为12.1厘米，腓骨瓣的长度为16.2厘米。除胫骨重建外，所有患者都取得了主要工会。腓骨联结的平均时间为5.4个月，在同种异体 - 宿主交界处和11.8个月。没有同种异体移植骨折和没有感染。五名患者有7个局部并发症。最终后续行动的MSTS平均得分为91.8％。负重的平均时间为12.4个月。结论：与大规模同种异体移植物组合的髓内腓骨瓣提供了在下肢恶性灭绝后重建大骨缺损的优异选择。腓骨的可行性是重建成功的基石，可防止同种异体移植壬尼，导致骨愈合减少，导致患者恢复和功能返回。

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