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題名 | Reconstructing Humerus Defects after Tumor Resection Using an Intramedullary Cortical Allograft Strut=使用區段異體皮質骨重建大型肱骨良性骨腫瘤的臨床報告 |
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作者姓名(中文) | 施信農; 施麗媛; 程俊穎; 徐郭堯; 張宗訓; | 書刊名 | 長庚醫學 |
卷期 | 25:10 2002.10[民91.10] |
頁次 | 頁656-663 |
分類號 | 416.66 |
關鍵詞 | 異體皮質骨; 骨腫瘤; 骨癒合; 自體骨結合; Allogenous cortical strut; Bone tumor; Union; Allograft incorporation; |
語文 | 英文(English) |
中文摘要 | 背景:體積大於60立方公分的肱骨病灶會造成骨頭強度降低,甚至引起病理性骨折。治療這種大型的肱骨骨腫瘤除了徹底刮除腫瘤外,留下的骨骼缺損常需要特別的重建手術。重建此種大型骨骼缺損的方法有許多,卻各有其利弊和使用的限制。 方法:從1988到1997年間,共有29位大型的肱骨骨腫瘤的病患在長庚醫院接受治療。手術的方法為徹底刮除腫瘤組織後,以一根或多根區段異體皮質骨來重建骨略缺損。一方面利用此皮質骨當作內支牚物,所以不需要另外的鋼釘或髓內釘固定;另一方面,此皮質骨也可當作骨移植。在平均8.8年後進行功能評各及放射線追蹤檢查。並且就X 光的變化分析影響異體皮質骨在體內結合的因子。 結果:腫瘤常的結果顯示,除了一例病人死於不相關的疾病外,所有的病人都存活。29位病人中,只有一例病人有局部腫瘤復發,後來一經一次同樣的手術治療後,結果很好。另一例病人有殘留的腫瘤組織,在繼續追蹤中。25位病人功能評估為極優,其他病人為佳。放射線檢查顯示刮除腫瘤後的空腔在術後二個月即可見明題的癒合現象,在術後六個月可見幾乎完全的癒合。但異體皮質骨在體內與自體骨結合的速度很緩慢,甚至可能不會完全,追蹤至10年的病人,仍可見異體骨的外型。另外,小孩子的異體皮質骨在體內與自骨骨結合的速度快於大,而骨缺損的大小、異體皮質骨的長度、及是否有補充切碎的海綿骨等並不影響異體皮質在體內與自體骨結合的速度。 結論:區段異體皮質骨不只可以重邁大型肱骨骨骼缺損,提供足夠的穩定力量使得肱骨不會骨折或變形,本身也是移植骨,可加速骨缺損的癒合速度,是個治療大型肱骨骨骼缺損的不錯選擇。尤其使用於小孩子,既不需取自體骨,又有較佳的與自體骨癒合的速度,遠較其他的重建方法好。 |
英文摘要 | Background: The humerus is a frequent involvement site of benign bone lesions. Various reconstruction methods have been adopted to restore the defect after excavating the lesion and/or to treat associated pathological fractures. In this study, we reviewed the clinical outcomes of using allogenous cortical struts to the treatment of patients with large humeral defects resulting from benign bone lesions, and investigated the mid-term fate of implanted allografts. Methods: From 1988 through 1997, 29 patients with space-occupying humeral lesions were treated by eradication of the tumor and reconstruction with an intrameduallary allogenous cortical strut. No additional internal fixation was needed for support. Clinical data were recorded, a dn functional and radiographic results were evaluated. Results: The sizes of defects after eradication of the lesions ranged from 61 to 122 ml (mean, 92 ml). the patients were followed for a mean of 8.8 years. One local recurrence was noted and was successfully treated by repeating the procedure. All patients achieved good to excellent functional results. Follow-up radiographs showed complete healing of the defects, with partial to complete incorporation of the allograft into the host bones. Children had a better chance of complete allograft incorporation than adults. Conclusion: Intramedullary allogenous cortical struts act as internal splint mechanically and bone graft material biologically. The combined use of intramedullary alogenous cortical struts and chipped cancellous bone grafts provided good stability and healing probability for large osseous defects in the humerus without the need for implant fixation. Allograft incorporation occurred slowly in adults and might not achieve complete incorporation in adults. |
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