Reconstruction with Replantation of the Resected Bone after Low Heat Treatment for Malignant Pelvic Bone Tumors / 대한정형외과학회잡지

PURPOSE: This study evaluated the oncological and functional results of a surgical treatment for malignant pelvic bone tumors using a low-heat-treated autologous bone graft. MATERIALS AND METHODS: Eleven patients with malignant pelvic bone tumors who were followed-up for more than one year were enrolled in this study. There were six males and five females. The mean age was forty-one years and the mean follow-up period was thirty months. Nine patients had primary bone tumors and two patients had metastatic tumors with various histological origins. A surgical resection was carried out according to the anatomic location (Type I/II 3 cases, Type II 2 cases, Type II/III 6 cases). The surgical methods used were a wide resection, a low-heat-treated autologous bone graft, total hip arthroplasty and rigid internal fixation. The ISOLS score was used to determine the oncological outcome. RESULTS: The mean ISOLS score was 61.2% at the final follow-up. The index of pain and emotional acceptance showed high scores, but functional ability, support, walking ability and gait showed relatively low scores. Bone union was achieved at a mean post-operative 6 months. The post-operative complications were one case of a local recurrence, two cases of infection and one case of a dislocation of the total hip arthroplasty. CONCLUSION: A wide resection and reconstruction with a low-heat-treated autologous bone graft in malignant pelvic bone tumors were satisfactory oncologically as well as functionally in the brief period. However, a longer follow-up and an examination of more cases will be needed.

Reconstruction of Large Bone Defect after Bone and Soft Tissue Tumor Resection , using Jeat / 대한정형외과학회잡지

To fill the large bone defect after bone and soft tissue tumor resection, there are several options such as tumor prosthesis, bone cement with intramedullary nail, autogenous bone graft and allograft. We had used isotrophic autogenous bone graft by using the heat-treated bone removed from tumor site. We analyzed the periods for junctional union and regeneration of autoclaved or low-heat treated groups, and compared these two methods to know which method is better for reconstruction of the bone defect after tumor resection. From Jan. 1987 to Sept. 1993, twelve patients took heat-treated autogenous bone graft: 6 auto- claved, and 6 low heat-treated. Each group had 10 places of junction sites between host and grafted bone. The tumors were 2 cases of osteosarcoma, 3 parosteal osteosarcoma, 2 Ewing's sarcoma, 2 malignant soft tissue tumors, 1 giant cell tumor, and 2 metastases from thyroid cancer and synovial sarcoma. The graft sites were 4 in humerus, 4 pelvis and 4 femur. Two cases showed marginal surgical margin and others wide surgical margin. Here we compare4 the difference between autoclaved group(120℃, 2 atm., 20 min) and low heat-treated group(65℃, 30 min. in water) on the aspect of complications and period to achieve junctional union to host bone. Average follow-up period was 25.3(11 to 88) months. Graft related complications in autoclaved group were bone resorption(2 sites), fracture of grafted bone(2). For low heat-treated group there was no such complication. Nonunion occurred in 3 sites for autoclaved group and 1 for low heat-treated group. Average period for junctional union was 7.3 months(5 to 10 months) for autoclaved group and 6.1 months(5 to 9 months) for low heat-treated group. With these results, heat treated bone autograft may have several advantages such as easy accessi- bility, low cost and anatomical reconstruction of the bone defect. The low heat-treated autogenous bone graft may have more advantages than that of the autoclaved one, and this method may be ratio- nalized to fill the large bone defect made by tumor resection.