Alcohol-inactivated autograft replantation in reconstruction of bone defects in management of malignant bone tumors

doi:10.3969/j.issn.2095-252X.2015.05.005

Abstract：Objective To evaluate the clinical outcomes of alcohol-inactivated autograft replantation in reconstruction of bone defects in management of malignant bone tumors,and to analyze the related factors affecting the survival rate and functional results.Methods The clinical data of 53 patients with malignant bone tumors who were admitted and treated by alcohol-inactivated autograft replantation from January 1995 to June 2013 were retrospectively analyzed.The mean age was 17.7 years old (range: 9-49 years ).Twenty-three neoplasms were located in the distal femur,2 neoplasms in the middle femur,20 neoplasms in the proximal tibia,3 neoplasms in the distal tibia,3 neoplasms in the proximal humerus,1 neoplasm in the sacrum and 1 neoplasm in the ilium respectively.According to the Enneking system,48 patients were identiifed as stage Ⅱb and 5 patients as stage Ⅲ.Forty-four patients were diagnosed as osteosarcoma,6 patients as Ewing's sarcoma,1 patient as rhabdomyosarcoma,1 patient as chondrosarcoma,and 1 patient as non-Hodgkin's lymphoma.The postoperative results were evaluated according to the Musculoskeletal Tumor Society ( MSTS ) system and the International Society of Limb Salvage ( ISOLS ) graft evaluation method.A statistical analysis of the correlation among all the related factors,survival and postoperative function was conducted.Results The mean follow-up period was 55 months ( range: 13-216 months ).Thirty-nine patients were treated with wide resection and 14 patients with marginal resection.The average length of alcohol-inactivated autograft was 16.3 cm ( range: 5-26 cm ).The recurrence rate was 22.9％( 11/48 ) in stage Ⅱb group,and there were 9 cases of pulmonary metastases with the metastasis rate of 18.8％,6 death cases and 5 cases of survival with tumors.The recurrence rate was 15.9％( 7/44 ) in osteosarcoma group,and there were 6 cases of pulmonary metastases with the metastasis rate of 13.6％and 35 cases of survival during the follow-up of 3 years.The overall 5-year survival rate was 42.5％,which was 54.5％in osteosarcoma group.Devitalized bone existed for a long time in 30 patients,among whom the overall 3-year survival rate was 57％( 30/53 ) and limb-salvage rate was 68％(36/53 ).The postoperative complications included incision infection (7.6％,4/53 ),fracture and internal ifxation breakage (9.4％,5/53),internal ifxation breakage (3.8％,2/53) and delayed union and non-union of inactivated bone (15.1％,8/53).The mean MSTS score was 27 (range: 19-33),and the mean ISOLS score was 26 (range: 22-31 ).The following results were achieved with the single factor analysis.(1) The length of alcohol-inactivated autograft was correlated with the occurrence rate of callus,the occurrence time of callus,postoperative recurrence rate,overall survival rate,MSTS score and ISOLS score (P＜0.05).(2) There was a correlation between neoplasm staging and postoperative recurrence rate (P＜0.05).(3) There was a correlation between joint preserving and MSTS score (P＜0.05).(4) The disease course,neoplasm staging (P=0.026 ) and tumor location were correlated with the 3-year survival rate (P＜0.05 ).The multiple-factor analysis showed the length of alcohol-inactivated autograft,duration of disease course and neoplasm staging were independent factors affecting the overall survival rate (P＜0.05 ).Conclusions Alcohol-inactivated autograft replantation could be an option in reconstruction of bone defects in management of malignant bone tumors.Early diagnosis and treatment could increase the survival rate.The functional results will be improved with the decrease of alcohol-inactivated autograft length and preservation of articular surface.The length of alcohol-inactivated autograft,duration of disease course and neoplasm staging are independent factors affecting the overall survival rate.