استفاده از آلوگرافت هاي استيوآرتيكولار براي بازسازي نقص ايجاد شده پس از برداشت تومورهاي قسمت فوقاني قسمت فوقاني تي بيا

Osteoarticular Allografts for Reconstruction of Defects after Resection of Proximal Tibia Tumors

Background: Osteoarticular allograft is used to reconstruct a joint which has been resected for tumor involvement. Variable results of success have been reported. For proximal tibial tumors, resection with a wide margin is often possible. An osteoarticular allograft reconstruction can be used instead of: Fusion, amputation, rotation-plasty, allograft-prosthesis composite or tumor prosthesis replacement. This is a report of our experience with such a treatment. Materials and Methods: 25 patients were studied in case-series method. Osteoarticular allograft was used in 25 patients to reconstruct skeletal defect after resection of a tumor in the proximal end of the tibia. The status of each allograft and the condition of each involved Iimb was evaluated for an average of 18.5 month (Range 5-41) postoperatively. Status of allograft was evaluated according to the survival of the allograft and the occurrence of complications. Results: Three complications occurred in association with 25 original allograiis that needed further surgery including infection (3 patients), non-union (1 patient), allograft fracture (3patients), local recurrence which led to above knee amputation (5 patients), instability of joint (1 patient). Three patients died. 2 due to distant metastasis and one due to septicemia. In the latest follow-up examination, 15 patients had retained the original allograft, 1 patient had a second allograft: procedure, 5 had an above-knee amputation and one allograft was removed due to infection and replaced with spacer. Based on Mankiri et al system the finial results revealed an excellent or good in 16 and fair or failure in 9 patients. The mean MSTSscore was 27 (90%) excluding 3 expired patients. Conclusion: Osteoaxticular allograft reconstruction, despite itʹs high complication - in particular infect; and fracture - is a reasonable substitute for proximal Tibial tumor-resection defects.