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Reconstruction of segmental bone defect of long bones after tumor resection by devitalized tumor-bearing bone.

Qu H, Guo W, Yang R, Li D, Tang S, Yang Y, Dong S, Zang J - World J Surg Oncol (2015)

Bottom Line: Incubation in 20% sterile saline at 65 °C for 30 min is an effective method of devitalization of tumor-bearing bone.The retrieved bone graft may provide as a less expensive alternative for limb salvage.The structural bone and the preserved osteoinductivity of protein may improve bone union.

View Article: PubMed Central - PubMed

Affiliation: Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China. wwwquhuayi@163.com.

ABSTRACT

Background: The reconstruction of an intercalary bone defect after a tumor resection of a long bone remains a challenge to orthopedic surgeons. Though several methods have been adopted to enhance the union of long segmental allografts or retrieved segmental autografts to the host bones, still more progresses are required to achieve a better union rate. Several methods have been adopted to devitalize tumor bone for recycling usage, and the results varied. We describe our experiences of using devitalized tumor-bearing bones for the repairing of segmental defects after tumor resection.

Methods: Twenty-seven eligible patients treated from February 2004 to May 2012 were included. The segmental tumor bone (mean length, 14 cm) was resected, and then devitalized in 20% sterile saline at 65 °C for 30 min after the tumor tissue was removed. The devitalized bone was implanted back into the defect by using nails or plates.

Results: Complete healing of 50 osteotomy ends was achieved at a median time of 11 months (interquartile range (IQR) 9-13 months). Major complications included bone nonunion in four bone junctions (7.4%), devitalized bone fracture in one patient (3.7%), deep infection in three patients (11.1%), and fixation failure in two patients (7.4%). The bone union rates at 1 and 2 years were 74.1 and 92.6%, respectively. The average functional score according to the Musculoskeletal Tumor Society (MSTS) 93 scoring system was 93 % (IQR 80-96.7%).

Conclusions: Incubation in 20% sterile saline at 65 °C for 30 min is an effective method of devitalization of tumor-bearing bone. The retrieved bone graft may provide as a less expensive alternative for limb salvage. The structural bone and the preserved osteoinductivity of protein may improve bone union.

No MeSH data available.


Related in: MedlinePlus

A 26-year-old male patient with an Ewing sarcoma in the middle part of the right femur. a Radiograph showed a lytic lesion in the diaphysial region of the right femur. b MRI showed the lesion was about 8 cm. c A 12-cm segmental bone was resected, the soft tissue was removed, and the structural bone and the periosteum were preserved for divitalization. d Radiograph 2 weeks after the reconstruction showed that the devitalized bone fit the defect perfectly. e Continuous callus at the proximal junction and a perfect union at the distal junction were observed 8 months after the reconstruction
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Fig2: A 26-year-old male patient with an Ewing sarcoma in the middle part of the right femur. a Radiograph showed a lytic lesion in the diaphysial region of the right femur. b MRI showed the lesion was about 8 cm. c A 12-cm segmental bone was resected, the soft tissue was removed, and the structural bone and the periosteum were preserved for divitalization. d Radiograph 2 weeks after the reconstruction showed that the devitalized bone fit the defect perfectly. e Continuous callus at the proximal junction and a perfect union at the distal junction were observed 8 months after the reconstruction

Mentions: Twenty-seven patients who underwent tumor resection, bone devitalization, and reconstruction of long bones between February 2004 and May 2012 were included in this study. The inclusion criteria were as follows: (1) a primary long-bone tumor that required massive segmental resection to cure the disease, in which the joint on each end was preserved to maintain function (Figs. 2a and 3a); (2) no prior treatment; (3) availability of complete imaging data, pathology results, and follow-up information; and (4) a minimum of 12 months of follow-up after surgery. A flow chart of how the patients were recruited is summarized in Fig. 1. Informed consent was obtained from all patients.Fig. 1


Reconstruction of segmental bone defect of long bones after tumor resection by devitalized tumor-bearing bone.

Qu H, Guo W, Yang R, Li D, Tang S, Yang Y, Dong S, Zang J - World J Surg Oncol (2015)

A 26-year-old male patient with an Ewing sarcoma in the middle part of the right femur. a Radiograph showed a lytic lesion in the diaphysial region of the right femur. b MRI showed the lesion was about 8 cm. c A 12-cm segmental bone was resected, the soft tissue was removed, and the structural bone and the periosteum were preserved for divitalization. d Radiograph 2 weeks after the reconstruction showed that the devitalized bone fit the defect perfectly. e Continuous callus at the proximal junction and a perfect union at the distal junction were observed 8 months after the reconstruction
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4581416&req=5

Fig2: A 26-year-old male patient with an Ewing sarcoma in the middle part of the right femur. a Radiograph showed a lytic lesion in the diaphysial region of the right femur. b MRI showed the lesion was about 8 cm. c A 12-cm segmental bone was resected, the soft tissue was removed, and the structural bone and the periosteum were preserved for divitalization. d Radiograph 2 weeks after the reconstruction showed that the devitalized bone fit the defect perfectly. e Continuous callus at the proximal junction and a perfect union at the distal junction were observed 8 months after the reconstruction
Mentions: Twenty-seven patients who underwent tumor resection, bone devitalization, and reconstruction of long bones between February 2004 and May 2012 were included in this study. The inclusion criteria were as follows: (1) a primary long-bone tumor that required massive segmental resection to cure the disease, in which the joint on each end was preserved to maintain function (Figs. 2a and 3a); (2) no prior treatment; (3) availability of complete imaging data, pathology results, and follow-up information; and (4) a minimum of 12 months of follow-up after surgery. A flow chart of how the patients were recruited is summarized in Fig. 1. Informed consent was obtained from all patients.Fig. 1

Bottom Line: Incubation in 20% sterile saline at 65 °C for 30 min is an effective method of devitalization of tumor-bearing bone.The retrieved bone graft may provide as a less expensive alternative for limb salvage.The structural bone and the preserved osteoinductivity of protein may improve bone union.

View Article: PubMed Central - PubMed

Affiliation: Musculoskeletal Tumor Center, People's Hospital, Peking University, Xizhimen Nan 11#, Xicheng District, Beijing, 100044, China. wwwquhuayi@163.com.

ABSTRACT

Background: The reconstruction of an intercalary bone defect after a tumor resection of a long bone remains a challenge to orthopedic surgeons. Though several methods have been adopted to enhance the union of long segmental allografts or retrieved segmental autografts to the host bones, still more progresses are required to achieve a better union rate. Several methods have been adopted to devitalize tumor bone for recycling usage, and the results varied. We describe our experiences of using devitalized tumor-bearing bones for the repairing of segmental defects after tumor resection.

Methods: Twenty-seven eligible patients treated from February 2004 to May 2012 were included. The segmental tumor bone (mean length, 14 cm) was resected, and then devitalized in 20% sterile saline at 65 °C for 30 min after the tumor tissue was removed. The devitalized bone was implanted back into the defect by using nails or plates.

Results: Complete healing of 50 osteotomy ends was achieved at a median time of 11 months (interquartile range (IQR) 9-13 months). Major complications included bone nonunion in four bone junctions (7.4%), devitalized bone fracture in one patient (3.7%), deep infection in three patients (11.1%), and fixation failure in two patients (7.4%). The bone union rates at 1 and 2 years were 74.1 and 92.6%, respectively. The average functional score according to the Musculoskeletal Tumor Society (MSTS) 93 scoring system was 93 % (IQR 80-96.7%).

Conclusions: Incubation in 20% sterile saline at 65 °C for 30 min is an effective method of devitalization of tumor-bearing bone. The retrieved bone graft may provide as a less expensive alternative for limb salvage. The structural bone and the preserved osteoinductivity of protein may improve bone union.

No MeSH data available.


Related in: MedlinePlus