ABSTRACT
El objetivo de este estudio fue analizar una serie de pacientes con osteosarcoma parostal de bajo grado y los resultados de su tratamiento quirúrgico y reconstrucción con un trasplante óseo. Se realizó una búsqueda retrospectiva en nuestra base de datos oncológica entre 1980 y 2010 de todos los pacientes con diagnóstico de osteosarcoma parostal. Se incluyeron para el análisis únicamente los osteosarcomas parostales de bajo grado, tratados quirúrgicamente con cirugía de conservación de miembro y reconstruidos con trasplante óseo cadavérico fresco congelado. Se incluyeron 22 pacientes en el estudio. La edad media de la serie fue de 32 ± 11 años (10-59) y el seguimiento medio de 93 ± 69 meses (8-237). La supervivencia global de los pacientes analizados fue de 91% (IC95%: 79-100) a 10 años. Cuatro pacientes (18%) presentaron una recidiva local de la enfermedad, dos de éstas fueron clasificadas histológicamente como osteosarcoma parostal desdiferenciado. Dos pacientes desarrollaron enfermedad a distancia, siendo el pulmón el único sitio de localización. La tasa de supervivencia de las reconstrucciones de la cirugía de conservación de miembro a 10 años fue de 65% (IC95%: 44-86). La supervivencia a largo plazo de los pacientes con osteosarcoma parostal de bajo grado es superior al 90%. La resección quirúrgica con márgenes amplios debe ser el tratamiento de elección y la reconstrucción biológica es una alternativa válida.
The objective of the study was to analyze a group of patients with low grade parosteal osteosarcoma treated with limb salvage surgery and reconstructed with bone allograft. A retrospective review from our oncologic data base between 1980 and 2010 was done and all patients with diagnosis of low grade parosteal osteosarcoma, treated with limb salvage surgery and reconstructed with allograft were included. Twenty-two patients were included for the analysis. The mean age was 32 ± 11 years (10-59) y the mean follow-up 93 ± 69 months (8-237). Ten year overall survival of the series was 91% (95%CI: 79-100). Four patients developed local recurrence, 2 of them histological classified after the resection dedifferentiated parosteal osteosarcoma. Two patients developed distant recurrence, being the lung the only site of metastasis. Ten year limb salvage reconstruction survival was 65% (95%CI: 44-86). Long term survival rate in low grade parosteal osteosarcoma is over 90%. Surgical resection wide margin should be the elective treatment and biological limb salvage reconstruction is a good alternative.
Subject(s)
Humans , Male , Female , Child , Adolescent , Adult , Young Adult , Osteosarcoma/surgery , Bone Transplantation/mortality , Limb Salvage/methods , Lung Neoplasms/secondary , Osteosarcoma/mortality , Osteosarcoma/pathology , Retrospective Studies , Follow-Up Studies , Treatment Outcome , Survivors , Rare Diseases/surgery , Rare Diseases/mortality , Rare Diseases/pathology , Kaplan-Meier Estimate , Neoplasm GradingABSTRACT
Limb salvage should be considered after complete remission in young and physically active patients with osteosarcoma. Herein we described a patient who was treated with whole knee allograft reconstruction for the clinical implications of biological reconstruction which can avoid the problems with several consecutive sessions of mega-prosthesis revision. The mid-term result of this whole knee joint allograft reconstruction showed that it provided optimal joint congruence with durable joint stability, well balanced mechanical axis without joint space narrowing, and satisfactory gait pattern.
Subject(s)
Humans , Allografts , Axis, Cervical Vertebra , Gait , Joints , Knee , Knee Joint , Limb Salvage , OsteosarcomaABSTRACT
PURPOSE: We aimed to assess the treatment outcomes and factors affecting bone union of intercalary allograft reconstruction after primary malignant bone tumor resection around the knee. MATERIALS AND METHODS: Twenty-one patients who underwent intercalary allograft reconstruction after resection of a malignant tumor of femur or tibia were retrospectively reviewed. The average follow-up period was 46.4 months. Location of the tumor was as follows: femur in 12 cases and tibia in 9. Osteosarcoma was the most common tumor (12 cases). Intercalary allograft was internally fixed with an intramedullary (IM) nail in 3 cases, with a plate in 12 cases and with an IM nail combined with a plate in 6 cases. The survival of the grafts and functional outcomes were evaluated. Factors affecting bone union and complications were assessed. RESULTS: All allografts survived without removal. The average Musculoskeletal Tumor Society functional score was 27. The mean length of the allograft was 16.7 cm and bony union took 10.9 months, in average. Nonunion occurred in 6 cases: at the diaphyseal side in 3, and the remaining 3 at the metaphyseal side. The graft length was shorter than average in all the diaphyseal side nonunion cases and longer than average in all the metaphyseal side nonunion cases. All cases of nonunion obtained bone union after additional operations (autologous bone graft alone: 1, bone graft with hardware change: 5). CONCLUSION: Survival and functional outcomes of intercalary allograft were satisfactory. Long allograft showed a tendency of fracture or nonunion at the metaphyseal side. Nonunion could be managed with additional operation without allograft removal.
Subject(s)
Humans , Femur , Follow-Up Studies , Knee , Nails , Osteosarcoma , Retrospective Studies , Tibia , Transplantation, Homologous , TransplantsABSTRACT
Objective To compare the clinical outcomes of anterior cruciate ligament(ACL)reconstruction by using allograft and autograft of patella tendon.Methods From August 2003 to December 2005,82 ACL reconstruction patients were studied retrospectively,including 59 cases using autograft of patellar bone-tendon-bone(BPTB)and 23 cases using BPTB allograft.Physical examination,scores of IKDC,Lysholm-Tegner and VAS as well as KT-2000 measurements were used for evaluation pre-and post-operation.Results 41 autograft and 17 allograft patients were finally followed up.One allograft patient suffered re-rupture of the reconstructed ligament.Positive ADT test were found in 5 autograft and 1 allograft patients and positive Lachman test were found in 3 autograft and 1 allograft patients.No statistically significant differences were revealed in ROM.IKDC,Lysholm-Tegner Score and KT-2000 measurements showed no significant differences between two groups,but VAS for autograft group were significantly higher than allograft group(P