加温処理骨移植を用いた骨軟部腫瘍切除後の再建とその成績

Reconstruction with Heat-treated Autologous Bone Grafts after Malignant Tumor Resection

　背景：骨・軟部腫瘍切除後に加温処理骨を用いた再建法の有用性について明らかにすること．

　対象と方法：当施設で加温処理骨移植を用いて再建を行った骨軟部腫瘍20例(発生部位は下肢17例，骨盤3例)に対し腫瘍学的予後，術後患肢機能，合併症について検討した．

　結果：最終経過観察時，無病生存(CDF)：13例，腫瘍なし生存(NED)：2例，腫瘍あり生存(AWD)：1例，病死(DOD)：4例であった．19例(95％)に骨癒合が得られ，平均骨癒合期間は8.8カ月であった．術後患肢機能はほぼ術前に想定した歩行能力を獲得した．局所再発は全例に認めず，合併症は35％であった．

　まとめ：Inlay-graftや血管柄付骨移植を併用するhybrid typeは骨癒合・機能ともに良好な成績であるが，高率に合併症が発生するとされる臼蓋周囲の腫瘍切除後や，intercalary graft単独でも，罹患骨の状態や患者の予後予測などを考慮して適切な治療を選択すれば，良好な成績を得ることが可能である．

　Background：This study is aimed to clarify the efficacy of reconstruction with heat-treated autografts.

　Methods：We evaluated 20 consecutive cases in which tumor resection had been followed by reconstruction with heat-treated autografts between 2002 and 2010.　The tumor site was a lower limb in 17 cases and the pelvis in 3 cases.　We retrospectively analyzed the oncological results, bone union, ambulatory function, and complications.

　Outcome：After a mean follow-up period of 44 months no local recurrences have been observed, and 15 patients are disease-free.　Union at the host-graft junction was observed in 19 of the 20 patients (95%) at an average of 8.8 months postoperatively.　Eighteen of the 20 patients regained excellent walking function.　Complications developed in 7 patients (35%) and consisted of infection in 3 patients, bone resorption in 2 patients, a fracture in 1 patient, and non-union in 1 patient.

　Conclusion：Reconstruction by inlay grafting and combination with a vascularized fibula (hybrid) yielded excellent results.　On the contrary, osteoarticular and simple intercalary grafting should be applied in selected cases, because they were related with a high complication rate.