65℃熱処理自家罹患骨を用いた骨軟部悪性腫瘍の治療成績

Heat-Treated Autogenous Bone Graft Following Resection of Malignant Bone and Soft Tissue Tumors

　抄録：骨軟部悪性腫瘍の切除後に行った熱処理自家骨移植の治療成績を検討した．対象は1994年から2001年まで治療した18例で，疾患は原発性骨悪性腫瘍13例，転移性骨腫瘍3例，骨合併切除を行った悪性軟部腫瘍が2例だった．部位は上腕骨3例，大腿骨7例，けい骨6例，骨盤2例で，移植法は節状骨移植5例，骨軟骨移植2例，欠損部補填5例，人工物との組み合わせが6例だった．骨癒合は15例（83％）に認め，残りの3例中2例は術後感染による移植骨の抜去，1例は死亡例で骨癒合が確認できなかった．術後合併症は感染を骨盤2例，けい骨近位2例，計4例（22％）に，骨折を大腿骨1例に認めた．骨癒合期間はX線所見上3～66カ月で認めた．骨癒合まで2年以上を要した2例は，セメントレス人工膝関節との組み合わせ例だった．熱処理自家骨移植を行ううえで，移植骨の固定性が重要で，軟部の合併切除が大きい骨盤，けい骨移植例については感染を十分考慮する必要がある．

　Between 1994 and December 2001, reconstruction with a heat-treated (60℃ for 30 min) autogenous bone graft was performed in 18 patients：13 with malignant bone tumors, 3 with metastatic bone tumors, and 2 with malignant soft tissue tumors. There were 10 males and 8 females, and their ages ranged from 9 to 64 years (mean, 30 years). The type of reconstruction was an intercalary graft in 5 cases, an osteoarticular graft in 2 cases, a graft and knee prosthesis composite in 6 cases, and a partial graft bone replacement in 5 cases.

　There were no tumor recurrences at the bone graft sites. Complications consisted of 4 cases of infection (2 of the pelvis, 2 of a tibia) and 1 case of fracture (femur). Healing and incorporation of the graft bone were observed in 15 cases. The time for healing at the osteosynthesis site varied from 3 to 66 months. Both cases of delayed union (66 and 30 months) were cases in which a cementless knee prosthesis composite graft had been used. Heat-treated autogenous bone grafts were useful for reconstruction after massive bone resection.