Clinical outcomes of alcohol-inactivated autograft replantation with articulation preservation for osteosarcoma in the distal femur
YU Xiu-chun
XU Song-feng
XU Ming
YUAN Ye
SU Qing
Abstract：Objective To investigate the clinical outcomes of alcohol-inactivated autograft replantation with articulation preservation in the treatment of osteosarcoma in the distal femur, to analyze the occurrence of common complications and to propose the treatment strategies. Methods From January 2004 to May 2011, 10 patients with osteosarcoma in the distal femur were treated with alcohol-inactivated autograft replantation with articulation preservation. There were 7 males and 3 females, with an average age of 20.1 years old and a median age of 21 years old ( range;15-24 years ). Neoplasms were located in the left distal femur in 6 cases, and in the right distal femur in 4 cases. According to the Enneking staging system, 9 patients were identiifed as stage II B and 1 patient as stage III. The postoperative outcomes were evaluated according to the Musculoskeletal Tumor Society ( MSTS ) rating scale, and the International Society of Limb Salvage ( ISOLS ) composite graft scores were calculated. Results All the 10 cases were healed by primary intention. The mean follow-up period was 34 months ( range;12-110 months ). One patient died of local recurrence and systemic multiple metastases 13 months after the operation, and 3 patients died of systemic multiple metastases at 9, 12 and 24 months after the operation respectively. Three patients ( 30%) experienced the second operation of open reduction, bone implantation and internal ifxation with the embracing ifxator at 2-9 months after the operation because of inactivated bone fractures. One of them died at 6 months after the operation. One got bone healing at 4 months after the operation with no abnormal signs during the 48-month follow-up. One of the above 3 patients experienced the third operation of open reduction and bone implantation with plate internal ifxation because of the fractures 13 months after the second operation, who got bone healing at 6 months after the operation but had joint instability and limited knee lfexion during the 12-month follow-up. The mean ISOLS score was 31 points (87%) ( range;28-34 points ). The mean MSTS functional score was 23 points ( 77%) ( range;19-28 points ). Conclusions Based on the premise that the indications are strictly mastered, alcohol-inactivated autograft replantation with articulation preservation is a feasible operation method in the treatment of osteosarcoma in the distal femoral metaphysis, with the advantages of preserving important joint structures, good matching between the tumor-bearing bone and the host bone and no immunologic rejection. The inactivated bone fracture is the most common complication. The main causes of fractures are the change of inactivated bone quality and the inappropriate choice of internal ifxation. The fracture rate will be signiifcantly decreased if plate ifxation is chosen and the time of external ifxation is prolonged.
Keywords：OsteosarcomaFemurBone neoplasmsReplantationDry scale end
Publication Date：2014-01-01
Online Publishing Date：2025-08-15(First online date of this platform, not the publication date of the document)
Pages：6( 120-125 )