Objective To evaluate the shortterm efficacy of osteoarticular allografts in the limb salvage of the proximal tibia. Methods From 1998 to 2003, 15 patients (7 males, 8 females; aged 14-56 yr, average 33) with bone tumor of the proximal tibia underwent osteoarticular allografts, among whom 7 had progressive giant cell tumor without any previous chemotherapy; 8 had malignant tumor with previous chemotherapy, including 6 patients with osteosarocoma, 1 with spindle cell sarcoma, and 1 with malignant fibrous histiocytoma. According to the Enneking system, the patients were classified into ⅠB (7 patients), ⅡA (2 patients), and ⅡB (6 patients). All the patientsunderwent the marginal resection with an allograft (average length 12 cm, range6-16 cm) implanted. Results The follow-up for an average of 21 months (range,3-58 months) revealed that among the 8 patients with malignant tumor of the proximal tibia undergoing chemotherapy, 5 had union of the bone, 3 had no union of the bone; among the 3 patients, 2 had a complication of infection and 1 had a local recurrence. All the 3 patients underwent amputation at the lower part of the femur. According to the Mankin score, 2 patients had a perfect result, 2 good, 1 fair, and 3 poor, with a 50% effectiveness rate. Among the 7 patients with progressive giant cell tumor at the upper part of the tibia, none had infection or local recurrence, but 2 hadnonunion of the bone and 2 had joint instability, aided by the kneeaidingsystem. According to the Mankin score, 3 patients had a perfect result, 2 good,and 2 fair, with a 71% effectiveness rate. Conclusion The osteoarticular allograft of the proximal tibia has many advantages in spite of a relatively highrate of complications, and it is the limb salvage of choicefor the progressivebenign or malignant bone tumors of the proximal tibia.
OBJECTIVE: To investigate the styles and affecting factors of bone union after massive frozen allografting for skeletal reconstruction owing to excision of bone tumor. METHODS: From 1992 to 1999, 85 patients suffering from bone malignant tumor were given the excision of large bone segment and treated with allografting in different methods of operation: large bone allografts with condylar articular surface in 16 cases, osteoarticular allografts in 57 cases, bone allografts in combination with prosthetic replacement of hip in 9 cases, and prosthetic replacement of knee in 3 cases. The average follow-up was 2 years and 9 months. The union time and styles of host-donor junction were determined by X-ray characters, and the results of operations were assessed according to Enneking’s functional evaluation system of reconstructive procedures after surgical treatment of tumors for the musculoskeletal system. RESULTS: There were 4 kinds of basic bone union styles by the X-ray characters, there were no significant difference in the time span of bone union after fixation with different methods. Of the 85 fresh-frozen allografting procedures, more than 80% of the patients were treated with interlocked intramedullary nail and allograft-prosthesis combination, and the overall result was excellent and good. Sufficient blood supply was important for host-donor junction healing, but the function of immune response was uncertain. CONCLUSION: There were different styles of bone union after massive allografting. The recommended operative methods for massive allografts are stable internal fixation, sufficient blood supply, soft tissue repair and periosteal flap coverage.
OBJECTIVE: To study the reparative and reconstructive methods for the large bone defect due to the excision of bone tumor. METHODS: According to the size and shape of the bone defect, we selected the proper bone and joint or manipulated bone segment of the profound hypothermia freezing allograft and gave locked intramedullary nails or steel plate and screws for stable internal fixation. RESULTS: In the 22 cases, 20 survived without tumor and 2 died. One patient treated with the allograft of semi-knee joint was found rejection. Then the wound did not heal. After the skin flap grafting was performed, the wound still did not heal, so the patient accepted amputation(4.5%). In the other 21 cases, the X-ray and 99mTc SPECT showed some callus or concentration of nuclein which implied bone union. According to Markin bone graft criterion, the excellent rate of function recovery was 81.8%. CONCLUSION: Allografting of bone and joint is a good and workable method in repairing and reconstructing the bone defect due to the excision of bone tumor. It should be further studied and be applied.