Use of massive bone allograft as a method of reconstruction after resection of bone tumours in the diaphysis of long bones

Tumori kosti lokalizirani u području dijafiza dugih kosti su rijetki. Nakon resekcije tumora zaostaje defekt kosti čija se rekonstrukcija može učiniti stranim materijalom (endoprotezom) ili presađivanjem kosti. Cilj je ovog rada bio analizirati rezultate primjene masivnih koštanih presadaka nakon resekcije tumora u dugim kostima. U istraživanje je uključeno 23 bolesnika iz Klinike za ortopediju KBC Zagreb, Medicinskog fakulteta Sveučilišta u Zagrebu, koji su bili operirani u razdoblju od 1999. do 2012. godine. Funkcionalni status bolesnika određivao se MSTS (MSTS, eng. Musculoskeletal Tumour Society score system) upitnikom i tijekom poslijeoperacijskog praćenja nije bilo značajnije promjene tog statusa u odnosu na prijeoperacijski status. Prerastanje koštanih presadaka bilo je definirano prerastanjem koštanog presatka na rentgenskim snimkama u dva korteksa na razini gdje je masivni koštani presadak bio u kontaktu s bolesnikovom vlastitom kosti, dok je potpuno prerastanje bilo definirano prerastanjem koštanog presatka u sva četiri korteksa na promatranoj razini. Medijan vremena prerastanja koštanih predsadaka koji su prerasli, iznosio je 4 mjeseca (raspon od 2 do 12 mjeseci), dok je medijan vremena potpunog prerastanja iznosio 12 mjeseci (raspon od 2 do 16 mjeseci). Komplikacije liječenja zabilježene su u 56% bolesnika. Onkološke komplikacije, kao što je, primjerice, lokalni recidiv tumorske bolesti, imao je izravan negativan utjecaj na preživljenje bolesnika. Ovu komplikaciju imalo je 18% bolesnika. Bolesnici s neonkološkim komplikacijama (mehaničke komplikacije osteosinteze, infekcija i neprerastanje koštanog presatka) liječeni su dodatnim operacijskim zahvatima. Udio mehaničkih komplikacija osteosinteze iznosio je 18%, a udio infekcija i neprerastanja koštanog presatka iznosio je jednako (4%). Nije pronađena povezanost između rezultata liječenja i drugih individualnih karakteristika bolesnika. Rekonstrukcija masivnim koštanim presadcima u ranom poslijeoperacijskom tijeku ima nešto više mehaničkih komplikacija u odnosu na primjenu tumorskih endoproteza, no superiorna je metoda zbog značajno boljeg dugoročnog preživljenja ekstremiteta.Bone tumours located in the diaphysis are rare. After a bone tumour resection there is a defect which can be reconstructed with foreign material (endoprosthesis) or with bone graft. Aim of this study was to investigate the results of massive bone allografts use after resection of the tumours in long bones. Study was conducted among 23 patients treated in the Department of Orthopaedic Surgery, Clinical Hospital Centre Zagreb, between 1999 and 2012. Functional status of patients was established through MSTS (MSTS, Musculoskeletal Tumour Society score system) questionnaire. During postoperational following functional status was not significantly improved compared to preoperational status. Host bone - allograft junction union was defined as union of an allograft, visible on radiographs, on two cortices where massive bone allograft was in contact with the patient’s bone, while complete union was defined as union on four cortices of an observed level. Median of time of union of allografts that were unioned was 4 months (range 2 to 12 months), whilst the median of time of complete union was 12 months (range 2 to 16 months). Complications were registered among 56% of patients. Oncological complication, such as local recurrence of the tumour, had a direct negative influence on survival. This complication had 18% of patients. Patients with non-oncological complications (mechanical complications of osteosynthesis, infection and non-union), were candidates for additional surgical procedure. Mechanical complications of osteosynthesis had 18% of patients, infection 4% and non-union also 4%. No significant correlation between results of treatment and other individual patients' characteristics was found. Reconstruction with massive bone allografts has a higher rate of mechanical complications comparing to reconstruction with endoprostheses, but is a superior method due to significantly better long-term survival of an extremity