脛骨骨幹部広範囲欠損に対する体外照射自家処理骨と血管柄付き骨移植の併用による再建

概要

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Several procedures are available for the reconstruction of massive bone defects following resection of malignant tumors. Recently, the new techniques of extracorporeally-irradiated bone autograft and vascularized bone graft were reported. However, the complication rate after surgery appears to be higher than expected. Combined use of extracorporeally-irradiated bone and vascularized bone would seem to be the ideal graft process for reconstruction because of the cumulative advantagesarising from this approach. Five patients (14-57 years, mean age 32.4) with a malignant tibial tumor were treated surgically with a combination of vascularized bone graft and extracorporeally-irradiated autograft. In 4 patients, the vascularized bone graft were successful without vascular complication. The mean period until the start of full weight bearing was 9 months (range 8-10) and the MTS score was classified as good to excellent with a mean score of 94 points (range 87-100). No local recurrences arising from the irradiated bones were detected. In one case, the vascularized scapula graft transplanted was totally necrotic due to venous thrombus. Combined use of free vascularized bone graft and extracorporeally-irradiated autograft proved to be a reliable procedure for the reconstruction of massive bone defects following resection of a malignant tumor.This procedure is best suited for intercalary defects of the tibia.
中国・四国整形外科学会の論文