ChineseJournalofReparativeandReconstructiveSurgery,January2008,Vol.22,No.1·102·•异体及异种移植•异体锁骨移植重建锁骨肿瘤切除后骨缺损郭征王臻王哲张涌泉【摘要】目的评价异体锁骨移植重建锁骨肿瘤切除后骨缺损的方法及效果。方法2000年1月－2006年1月，对9例锁骨肿瘤患者行肿瘤瘤段切除、异体锁骨联合钢板修复重建术。其中男4例，女5例；年龄12～68岁。良性肿瘤和瘤样病变2例，Campanacci影像学分级均为Ⅲ级；原发性恶性和转移瘤共7例。病变位于锁骨外侧端3例、胸骨端2例、骨干4例，2例合并病理性骨折。根据Enneking功能评价标准，术前患肢功能优3例，良3例，可1例，差2例；术前疼痛等级评定（visualanaloguescale，VAS）示：中度以上静息痛4例，活动时中度以上疼痛3例，重度疼痛2例。肿瘤采用全切除方式，原发性恶性肿瘤和转移瘤术后分别局部辅助放疗和化疗，随访评价肿瘤控制、疼痛缓解、植骨愈合和肩关节功能等情况。结果9例患者均获随访12～70个月，平均34.6个月。随访期内未发现局部肿瘤复发，原发性恶性肿瘤未见远隔转移。术后外形良好，未见明显排斥反应，无深部感染发生。8例患者异体骨与自体骨间Ⅰ期愈合，愈合时间3.2～6.8个月，平均5.4个月，其中1例患者取内固定后因外伤造成异体骨骨折，再次行钢板内固定治疗，4个月后骨折愈合；另1例术后出现钢板松动、骨不连，经再次植骨后6个月愈合。Enneking功能评价：术后3个月优6例，良3例；6例患者随访24个月时，优4例，良1例，可1例。VAS评定示术后3个月仅2例上肢活动时出现轻度疼痛；术后12个月，7例无疼痛，活动时中度和轻度疼痛各1例。结论异体锁骨是锁骨肿瘤切除后残留骨缺损的一种良好重建材料，重建后患肩的外形和功能满意，疼痛减少，生活质量提高。【关键词】锁骨肿瘤异体骨移植重建中图分类号：R738.1R687.34文献标志码：AALLOGRAFTOFCLAVICLEFORRECONSTRUCTIONOFBONEDEFECTAFTERTUMORRESECTION/GUOZheng,WANGZhen,WANGZhe,ZHANGYongquan.InstituteofOrthopaedics，XijingHospital，theFourthMilitaryMedicalUniversity，Xi’anShaanxi,710032，P.R.China.Correspondingauthor:GUOZheng,E-mail:guozheng@fmmu.edu.cn【Abstract】ObjectiveToevaluatetheeffectsofallogeneicbonegraftforreconstructingbonedefectofclavicleaftertumorresection.MethodsNinepatientsreceivedthesurgicalproceduresforrepairingandreconstructingbonedefectafterresectionofclavicletumorfromJanuary2000toJanuary2006.Therewere4malesand5femalesaged12to68years.Twopatientswerediagnosedashavingbenigntumorandtumor-likelesion(stageⅢaccordingtoCampanaccigrading),and7ashavingprimarymalignanttumorandmetastaticcancer.Threelesionswerelocatedinacromialend,2insternalendand4inshaftofclavicle.Twocaseswasaccompaniedbypathologicalfracture.AccordingtoEnneking’sfunctionalevalutation,theresultswereexcellentin3cases,goodin3cases,fairin1caseandpoorin2cases.Basedonthevisualanaloguescale(VAS),painwasratedasmediumrest-painin4cases,asmediummove-painin3casesandheavypainin2casespreoperatively.Thetumorwasresectedwithenbloc.Defectedclavicleswerereconstructedbyapartofallograftclavicleandplate.Thepatientswithmalignanttumorreceivedneo-adjuvantche-motherapyandradiotherapypostoperatively.Theresultswereevaluatedaccordingtocontroloftumor,reliefofpain,bonehealingandshoulderjointfunction.ResultsThesepatientswerefollowedup12to70months(mean34.6months).Therewerenolo-calrecurrenceandmetastasesinallpatientsduringthefollow-up.Nocomplicationsofimmunerejectionanddeepinfectionwereseen.Thenormalshapeoftheshoulderswasrestored.Eightofallpatientsshowedprimarybonehealingbetweenallograftboneandhostbone.Themeanhealingtimewas5.4months(3.2-6.8months).Looseningoftheplateandnonunionwereseenin1case;andbonegraftingwasgivenagain.Fractureofallograftoccurredin...
