Long-term Effect Of Half-joint Allograft Transplantation For Bone Tumors

Limb salvage treatment of bone tumor is a surgical approach for the reconstruction of the whole bone tumor.The operation can not affect the survival rate of patients with the premise,the maximum degree of retention of the affected limb function.Limb salvage treatment of bone tumors of the proximal and distal limbs involves the complete resection of tumor lesions and functional reconstruction,especially in the aspect of joint function.In recent years,with the development of new materials and new technologies,alloarthroplasty and allograft-prosthetic composite(APC)gradually rise.Alloarthroplasty can achieve joint reconstruction without rely on bone healing,patients can be active.But postoperative infection,prosthesis loosening,serious wear and tear.The revision is more difficult because of bone defects.Bone bank provide the half-joint allograft,its size and shape can match the receiver basically.The joint surface and cartilage of the half-joint allograft can be used long-term by receiver if bone healing.The defect is more postoperative complications and limited joint function,which affected the promotion and use.Objective: To investigate the feasibility and clinical effect of the patients with Half-joint Allograft Transplantation in the treatment of bone tumor near extremity joint.Method :A retrospective analysis of 15 consecutive cases who were treated with allograft reconstruction between 1993 and 2003,8 male and 7 female had a mean age of 36 years(range,11~58 years).The histologic diagnoses leading to segmental resection include 9 gaint cell tumor,2 aneurismal bone cyst,2 osteosarcoma,1 chondrosarcoma.The tumors were located in the distal femur(eight patients),proximal tibia(one),proximal humerus(two),distal radius(four).Followed up to observe the postoperative complications,according to X-ray assessment of bone healing,the application of international society of limb salvage(ISOLS)imaging scoring system and Musculoskeletal Tomor Sciety(MSTS93)limb function scoring system to assess the feasibility and long-term efficacy of allograft with bone imaging and limb function score,Result:We performed a retrospective review of 15 patients.Minimun followup was 11 years(mean,15.4 years;range 11~18 years).Three of whom die of tumor disease.Postoperative complications were recorded,infection in 1 case,nonunion in 1 case,fracture in 2cases,degenerative joint disease in all 12 cases.At last follow-up,12 patients with ISOLS imaging scoring system and MSTS93 limb function scoring system score were followed up,including 7 males and 5 females,of which 5 were located in the distal femur,1 in the proximal tibia,2 in the proximal humerus,and 4 in the distal radius.ISOLS imaging score system analyse objectively bone transplantation in patients according to the postoperative X-ray.The system include 9 indexes,each score 4 points,total score conversion into percentage was evaluated,the score indicators include: bone remodeling,interface,anchor age,implant body,fusion,resorption,fracture,graft shortening,fixation.The grade score,excellent: 75% or more,good: 50% ~ 74%,fair: 25% ~ 49%,poor is less than 25%.MSTS93 limb function scoring system include six indexes,each score of 5 points,a total of 30 points,the score index including pain,postoperative function of overall evaluation and acceptance,upper limb including hand position,hand fine activity and upper limb ability index,lower extremity including brace use,walking ability and gait indexes.Excellent: 24~30 points,good: 18~23 points,fair:12~17 points,poor: 12 points or less.The fellow-up average score of ISOLS imaging score was 81.9% and the average score of MSTS93 was 24,and all grades were excellent.Conclusion :The imaging score and functional score of the patients with near extremity joint bone tumor were excellent to that of the half-joint allograft transplantation.Half-joint allograft transplantation is an effective way to biological reconstruction after resection of the tumor,long-term efficacy and retain effective bone mass after successful limb salvage,It is of great significance for young and huge benign bone tumor patients.