Technique and results after immediate orthotopic replantation of extracorporeally irradiated tumor bone autografts with and without fibular augmentation in extremity tumors

BMC Musculoskeletal Disorders

Christof Birkenmaier¹  Yasmin Bakhshai¹  Andrea Baur-Melnyk²  Falk Roeder³  Hans Roland Dürr⁴  Alexander Klein⁴ 

[1] Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU, Munich, Germany;Department of Radiology, University Hospital, LMU, Munich, Germany;Department of Radiotherapy and Radiation Oncology, Landeskrankenhaus, Paracelsus Medical University, Salzburg, Austria;Musculoskeletal Oncology, Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, Marchioninistr. 15, 81377, Munich, Germany;

关键词: Irradiated bone;    Bone reconstruction;    Bone tumor;    Fibular graft;    Pseudarthrosis;    Autograft;   

DOI  :  10.1186/s12891-021-04629-3

来源: Springer

【 摘 要 】

BackgroundReconstruction of the skeletal defects resulting from the resection of bone tumors remains a considerable challenge and one of the possibilities is the orthotopic replantation of the irradiated bone autograft. One technical option with this technique is the addition of a vital autologous fibular graft, with or without microvascular anastomosis. The aim of our study was to evaluate the clinical results of the treatment of our patient cohort with a specific view to the role of fibular augmentation.MethodsTwenty-one patients with 22 reconstructions were included. In all cases, the bone tumor was resected with wide margins and in 21 of them irradiated with 300 Gy. In the first case, thermal sterilization in an autoclave was used. The autograft was orthotopically replanted and stabilized with plates and screws. Fifteen patients underwent an additional fibular augmentation, 8 of which received microvascular anastomoses or, alternatively, a locally pedicled fibular interposition.Resultsthe most common diagnosis was a Ewing sarcoma (8 cases) and the most common location was the femur (12 cases). The mean follow-up time was 70 months (16–154 months). For our statistical analysis, the one case with autoclave sterilization and 3 patients with tumors in small bones were excluded. During follow-up of 18 cases, 55.6% of patients underwent an average of 1.56 revision surgeries. Complete bony integration of the irradiated autografts was achieved in 88.9% of cases after 13.6 months on average. In those cases with successful reintegration, the autograft was shorter (n.s.). Microvascular anastomosis in vascularized fibular strut grafts did not significantly influence the rate of pseudarthrosis.Conclusionsthe replantation of extracorporeally irradiated bone autografts is an established method for the reconstruction of bone defects after tumor resection. Our rate of complications is comparable to those of other studies and with other methods of bone reconstruction (e.g. prosthesis). In our opinion, this method is especially well suited for younger patients with extraarticular bone tumors that allow for joint preservation. However, these patients should be ready to accept longer treatment periods.

【 授权许可】

CC BY