自体骨复合同种异体骨修复膝周骨巨细胞瘤微波原位灭活后骨缺损的效果OA
Effect of autologous bone and allogeneic bone in repair of bone defect after microwave in situ inactivation for bone giant cell tumor around the knee
目的 探讨自体骨复合同种异体骨修复膝周骨巨细胞瘤微波原位灭活后骨缺损的临床效果.方法 回顾性分析我院2015年1月至2022年12月收治的39例膝周骨巨细胞瘤患者的临床资料.先用微波原位灭活肿瘤组织,再予以刮除,然后用自体骨重建软骨下骨邻近的骨缺损,剩下的瘤腔采用自体骨与同种异体骨混合植骨,再用锁定钢板进行保护性固定.记录患者手术时间、术中出血量、住院时间、切口愈合及手术相关并发症等早期结果.术后定期随访,观察肿瘤复发、转移情况,记录内固定情况、植骨融合情况及其时间.术前及末次随访时采用国际骨肿瘤协会(MSTS)评分系统对膝关节功能进行评价.末次随访时采用Aboulafia分级系统对影像学关节退变进行评定.结果 患者手术时间平均(134.7±14.2)min,术中出血量平均(153.9±23.0)mL,住院时间平均(17.4±3.2)d.术后患者切口均Ⅰ期愈合,无神经血管损伤等手术相关并发症发生.患者术后均获得随访,随访期间无肿瘤局部复发及转移.末次随访时患者MSTS评分高于术前(P<0.05),术后膝关节功能恢复优良率为89.7%.末次随访时X射线片显示病灶填充良好、植骨融合,融合时间平均(9.4±2.1)个月;未出现关节面塌陷、骨折等.Aboulafia分级显示0级20例,1级11例,2级8例.结论 膝周骨巨细胞瘤微波原位灭活后用自体骨复合同种异体骨修复肿瘤刮除后的骨缺损,膝关节功能恢复理想,并可有效防止关节面塌陷和退变,有助于瘤腔重建.
Objective To investigate the clinical effect of autologous bone combined with allogeneic bone in repairing bone defect after microwave in situ inactivation for bone giant cell tumor around the knee.Methods A retrospective analysis was conducted on the clinical data of 39 patients with bone giant cell tumor around the knee treated in our hospital from January 2015 to December 2022.The tumor tissues of all patients were performed microwave in situ inactivation first,then followed by curettage;the subchondral bone defect adjacent to the articular surface was reconstructed with autologous bone graft,and the remaining tumor cavity was filled with a composite of autologous and allogeneic bone;then a locking plate was applied for protective fixation.The early outcomes including operative time,intraoperative blood loss,hospital stay,wound healing,and surgery-related complications were recorded.The regular follow-up was conducted after surgery,then the tumor recurrence or metastasis was observed and the status of internal fixation and bone graft fusion along with its fusion time were recorded.The knee functions before operation and at the end of follow-up were evaluated with the Musculoskeletal Tumor Society(MSTS)scoring system.The radiographic joint degeneration was evaluated by the Aboulafia classification system at the end of follow-up.Results The patients showed a mean operative time of(134.7±14.2)minutes,an averaged intraoperative blood loss of(153.9±23.0)mL,and a mean hospital stay of(17.4±3.2)days.The patients obtained Ⅰ phase wound healing without any surgery-related complications such as neurovascular injury.All patients underwent the postoperative follow-up,without local recurrence or metastasis cases during the follow-up.At the end of follow-up,the MSTS score of patients was higher than that before operation(P<0.05),with an excellent and good rate of knee function recovery of 89.7%.At the end of follow-up,X-ray films showed good filling of the lesion and bone graft fusion,with a mean fusion time of(9.4±2.1)months.No collapse or fracture of the articular surface occurred.According to the Aboulafia classification,there were 20 cases of grade 0,11 cases of grade 1,and 8 cases of grade 2.Conclusion The autologous bone and allogeneic bone in repair of bone defect after microwave in situ inactivation for bone giant cell tumor around the knee has perfect knee function recovery,and can effectively prevent the collapse and degeneration of articular surfaces,which helps in the reconstruction of tumor cavity.
夏平光;蒋翔;张宝成
中部战区总医院骨科,湖北 武汉 430070中部战区总医院骨科,湖北 武汉 430070中部战区总医院骨科,湖北 武汉 430070
医药卫生
骨巨细胞瘤微波原位灭活骨缺损自体骨同种异体骨
bone giant cell tumormicrowave in situ inactivationbone defectautogenous boneallogeneic bone
《局解手术学杂志》 2025 (9)
795-799,5
湖北省卫生计生委联合基金项目(WJ2018H0073)
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