RECONSTRUCTION OF BONE DEFECTS AFTER TUMOR RESECTION BY AUTOAND ALLOGRAFTS (review of literature)

Abstract

The problem of replacement of large bone defects resulting from segmental bone resections in patients with bone tumors is still actual in modern orthopedics. Segmental defects cause the main difficulty especially in cases of disturbance of normal biomechanics while the “gold standard” of reconstruction with bone autograft is not always possible. The reason is that the defect can be so extensive that would make it impossible to harvest necessary autobone stock. Therefore, allografts based on demineralized bone with optimal properties for osteoregeneration are used as an alternative for autograft. For certain composite materials it is possible to program the properties of future graft by changing its compound. Literature analysis revealed that the effectiveness of the allograft in combination with additional components is comparable to autograft effectiveness. Mesenchymal stem cells of both bone marrow and adipose tissue can be used as an additional component to improve osteoregeneration. It is noteworthy that the analyzed studies did not reveal the influence of stem cells on the tumor recurrence. Nevertheless, the authors support the need of further researches in this area to confirm gained results. Some authors still prefer traditional methods of bone traction despite obtaining own satisfactory results of defects reconstruction with allografts. Such opinion is based on proven effectiveness of the method, structural stability of construction during treatment period and ability to adjust the process of bone regeneration at any stage. The authors goal was to analyze publications over the recent 5 years with the results of experiments and clinical studies on the replacement of large bone defects after bone tumor resection with autoand allografts. Based on the literature analysis the authors propose a general algorithm for graft selection in replacement of large bone defects after segmental bone resections.