Evaluation of Clinical Results and Complications of Structural Allograft Reconstruction after Bone Tumor Surgery | ||
| The Archives of Bone and Joint Surgery | ||
| مقاله 8، دوره 4، شماره 3، مهر 2016، صفحه 236-242 اصل مقاله (710.56 K) | ||
| نوع مقاله: RESEARCH PAPER | ||
| شناسه دیجیتال (DOI): 10.22038/abjs.2016.6320 | ||
| نویسندگان | ||
| Mohammad Gharedaghi1؛ Mohammad Taghi Peivandi1؛ Mehdi Mazloomi1؛ Hasan Rahimi Shoorin* 2؛ Mohammad Hasani2؛ Parham Seyf3؛ Fatemeh khazaee4 | ||
| 1Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran | ||
| 2Department of Orthopedic Surgery, Kamyab Hospital, Mashhad, Iran Department of Orthopedic Surgery, Emam Reza Hospital, Mashhad, Iran | ||
| 3Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran | ||
| 4Mashhad University of Medical Sciences, Mashhad, Iran | ||
| چکیده | ||
| Background: Massive bone allograft is an option in cases of limb preservation and reconstruction after massive benign and malignant bone tumor resection. The purpose of this study was to analyze the outcome of these procedures at Imam Reza Hospital, Mashhad University of Medical Sciences. Methods: In this study, 113 cases have been presented. Eleven cases were excluded (patients has a traumatic defect or they passed away before the completion of the study’s two-year follow up period). Each patient completed a questionnaire, went through a physical examination and, if indicated, X-ray information was collected. The patients were divided into three groups: chemotherapy, chemotherapy plus radiation therapy, and no-adjuvant-therapy. Results: Fifty-four cases were male and the mean age was 24.5±5.39. The number of cases and indications for surgery were: 33 cases of aggressive benign tumors or low grade malignant bone tumors (large bone defects) including 16 germ cell tumors, eight aneurysmal bone cysts, five low grade osteosarcomas, and four chondrosarcomas. Another 69 cases were high-grade malignant bone tumors including 42 osteosarcomas, 21 Ewing’s sarcoma, and six other high grade osteosarcomas. Patients were divided into three groups: the first group received no adjuvant therapy, the second group received chemotherapy, and the third group received chemotherapy plus radiotherapy. The location of tumors were as follows: eight cases in the pelvic bone, 12 in the proximal femur, 18 in the femoral shaft, 36 in the distal femur, 12 in the proximal tibia, and 16 in the humeral bone. The 12 cases of proximal femoral defects were reconstructed by allograft composite prosthesis, 18 diaphyseal defects with intercalary allograft, and 36 distal femoral defects were reconstructed using osteoarticular allograft. The rate of deep infection was 7:8% (eight patients) and in this regard, we found a significant difference among the three groups, such that most cases of infection occurred in the adjuvant chemotherapy plus radiation therapy group. Allograft fracture occurred in six patients and prevalence was the same in all groups. Only in six cases of radio-chemotherapy nonunion occurred, so we used autogenous bone graft for union. Local recurrence was observed in six patients: three belonged to the adjuvant chemotherapy group and the other three were in the chemo-radiotherapy group; no significant difference was observed between these two groups. However, there was a significant difference between these two and the group that received no adjuvant therapy. Also, there were 11 cases of metastases and Restriction of knee joint motion occurred in 48 cases of osteo-cartilaginous grafts of the distal femur and proximal tibia. Conclusion: Although structural allograft is an appropriate choice in limb reconstruction after massive resection of involved tissues in malignant and invasive bone tumors, the risk of complications such as nonunion and infection in massive allograft increases in cases of adjuvant (chemotherapy and radiotherapy) modalities of treatment. Whereas the rate of tumor recurrence, metastasis, and restrictions in range of motion during a short term follow up after implantation showed no significant difference among the evaluated groups. Consequently, further attention and constant periodic visits of the patients and checking for local recurrence and distant metastasis should be done after surgery. | ||
| کلیدواژهها | ||
| Allograft؛ Bone tumor؛ chemotherapy؛ Limb-salvage؛ Radiotherapy | ||
| مراجع | ||
|
1. Jamshidi KH, Jabal Ameli M, Ameri Mahabadi E. The results of limb-salvage procedures for high grade osteosarcoma of the limbs. Razi J Med Sci. 2004; 10(38):835-43. 2. Anract P, Coste J, Vastel L, Jeanrot C, Mascard E, Tomeno B. Proximal femoral reconstruction with megaprosthesis versus allograft prosthesis composite. A comparative study of functional results, complications and longevity in 41 cases. Rev Chir Orthop Reparatrice Appar Mot. 2000; 86(3):278-88. 3. Bullens PH, Minderhoud NM, de Waal Malefijt MC, Veth RP, Buma P, Schreuder HW. Survival of massive allografts in segmental oncological bone defect reconstructions. Int Orthop. 2009; 33(3):757-60. 4. Tuominen T, JämsäT, Tuukkanen J, Nieminen P, Lindholm TC, Lindholm TS, et al. Native bovine bone morphogenetic protein improves the potential of biocoral to heal segmental canine ulnar defects. Int Orthop. 2000; 24(5):289-94. 5. Mankin HJ, Doppelt S, Tomford W. Clinical experience with allograft implantation. The first ten years. Clin Orthop Relat Res. 1983; 174:69-86. 6. Dick HM, Malinin TI, Mnaymneh WA. Massive allograft implantation following radical resection of high-grade tumors requiring adjuvant chemotherapy treatment. Clin Orthop Relat Res. 1985; 197:88-95. 7. Glasser DB, Lane JM. Stage IIB osteogenic sarcoma. Clin Orthop Relat Res. 1991; 270:29-39. 8. Deijkers RL, Bloem RM, Petit PL, Brand R, Vehmeyer SB, Veen MR. Contamination of bone allografts: analysis of incidence and predisposing factors. J Bone Joint Surg Br. 1997; 79(1):161-6. 9. Farfalli GL, Aponte-Tinao L, Lopez-Millan L, Ayerza MA, Muscolo DL. Clinical and functional outcomes of tibial intercalary allografts after tumor resection. Orthopedics. 2012; 35(3):e391-6. 10. Jamshidi K, Jabalameli M, Ameri E. The early results of massive osteoarticular allograft in the surgical treatment of lower limb bone tumors. J Kerman Univ Med Sci. 1998; 5(3):117-22. 11. Mankin HJ, Gebhardt MC, Jennings LC, Springfield DS, Tomford WW. Long-term results of allograft replacement in the management of bone tumors. Clin Orthop Relat Res. 1996; 324:86-97. 12. Nekouei A, Solouki S. The results of treatment of bone allograft transplantation in the treatment of primary malignant bone tumors in Namazi and Chamran Hospital. Shiraz: Shiraz University of Medical Sciences; 2013. 13. Donati D, Biscaglia R. The use of antibioticimpregnated cement in infected reconstructions after resection for bone tumours. J Bone Joint Surg Br. 1998; 80(6):1045-50. 14. Rodl RW, Ozaki T, Hoffmann C, Bottner F, Lindner N, Winkelmann W. Osteoarticular allograft in surgery for high-grade malignant tumours of bone. J Bone Joint Surg Br. 2000; 82(7):1006-10. 15. Donati D, Di Liddo M, Zavatta M, Manfrini M, Bacci G, Picci P, et al. Massive bone allograft reconstruction in high-grade osteosarcoma. Clin Orthop Relat Res. 2000; 377:186-94. 16. Vander Griend RA. The effect of internal fixation on the healing of large allografts. J Bone Joint Surg Am. 1994; 76(5):657-63. 17. Masterson EL, Masri BA, Duncan CP, Rosenberg A, Cabanela M, Gross M. The cement mantle in femoral impaction allografting. A comparison of three systems from four centres. J Bone Joint Surg Br. 1997; 79(6):908-13. 18. Friedlaender GE, Tross RB, Doganis AC, Kirkwood JM, Baron R. Effects of chemotherapeutic agents on bone. I. Short-term methotrexate and doxorubicin (adriamycin) treatment in a rat model. J Bone Joint Surg Am. 1984; 66(4):602-7. 19. Kumta SM, Leung PC, Griffith JF, Roebuck DJ, Chow LT, Li CK. A technique for enhancing union of allograft to host bone. J Bone Joint Surg Br. 1998; 80(6):994-8. | ||
|
آمار تعداد مشاهده مقاله: 1,993 تعداد دریافت فایل اصل مقاله: 2,407 |
||