A systematic approach to the surgical treatment of patients with long bone tumors using bone segmental alloimplants

Abstract

The most common techniques for the replacement of post-resection bone defects in patients with tumors are modular and individualendoprosthetics and bioreconstructive interventions. The following issues require solution: improvement and development of techniquesfor fixation of segmental allograft and recipient bone, study of bone remodeling processes in conditions of bone allograft andcytostatics (chemotherapy drugs) action, improvement of segmental allograft quality. Objective. To determine the indicationsfor allograft replacement of post-resection defects of long bones (and its types) in patients with malignant bone tumors. Methods.Experimental studies were carried out to study morphological, biomechanical, biochemical changes in experimental rats after boneallograft under different conditions. Using the finite element method, the tensely deformed conditions in the «allograft – recipientbone– endoprosthesis» system were assessed to determine the most effective fixation technique of the bone allograft and recipient bonein imitation of a bone regenerate in different terms after surgery. Results. The effectiveness of allograft prosthesis composite techniquewith a step-cut osteotomy and additional bone autoplasty in the contact zone of the allograft and the recipient bone was proven.It was determined that the use of radiation-sterilized bone allograft in combination with systemic administration of cytostatics leads toinhibition of bone formation. We developed an algorithm-scheme of surgical treatment of patients with tumors of long bones usingsegmental allograft and proposed methods of replacement of postresection bone defects for each localization of tumor lesions. Clinicalapprobation was performed. Conclusions. Segmental bone allograft of large post-resection defects of long bones at their tumorousaffection remains an actual and perspective technique of one bioreconstruction. Clear adherence to the indications for this techniquewill help to prevent complications and repeated operations.