Surgical treatment of bone tumors using segmental bone allografts

Abstract

The aim of the study is to improve the method of surgical treatment for patients with tumors of long bones with the use of segmental bone allograft. Material and method. The authors have improved the method of surgical treatment of patients with tumor bone lesions using segmental allografts. Step-cut osteotomy was performed to achieve the best contact between the allograft and the recipient bone, fixation was performed with intramedullar interlocking nail without the use of bone cement, and primary bone autoplasty was done to achieve better reparation. The method was clinically tested and the results of its application were studied (radiologically, morphologically). A morphological study of the contact zone between the allograft and the recipient's bone was conducted. Results. The effectiveness of the developed method was proved. As a follow-up result among patients who underwent surgical treatment according to the developed method, the following complications were noted: ischemic necrosis of soft tissues (due to intraoperative ligation of an artery which was surrounded by a tumor) – 1 case; tumor recurrence resulting in a limb amputation – 1 patient. During the macroscopic study of a removed fragment (after amputation), the fusion between allograft and recipient bone was observed. As a result of histological and X-ray examination, bone regeneration was seen in the area of contact between the allograft and the recipient bone. The histological examination also was used to clearly visualize the removed fragment of the affected tibia, in particular the contact zone between the allograft and the recipient bone, and the bone implant material, on the outer surface and internal parts of which, the formation of new bone tissue in the form of layering of the bone trabeculae was seen. Thus, the bone tissue was formed on the surface of allogeneic bone material and sprouted into its internal parts, forming a stiff bone – implant contact. Conclusions. Using the technique of bioreconstruction of the long bone defects allows the bone tissue of the affected limb to be preserved as much as possible, to restore the surrounding soft tissues and avoid infectious and allergic reactions in comparison with modular endoprosthetics. Fixation of the allograft and the recipient bone using step-cut osteotomy with the additional insertion of an interlocking intramedullar nail allows getting a stable «construction» and maximizing the contact zone of the bone tissue (the allograft and the recipient bone).