Biological Reconstruction in Malignant Bone Tumors

INTRODUCTION: There may be several reconstruction methods in order to eliminate the defects developed after the surgery of malignant bone tumors. In this study, we aimed to evaluate our functional results in the treatment of bone defects by biological reconstruction method after primary malign bone tumor surgery.
METHODS: Between 2003-2017 years,24 patients with primary malignant bone tumors undergone biological reconstruction were included into study.11 of the patients had Ewing’s sarcoma,8 of them had osteosarcoma,2 of them had malignant giant cell tumor,2 of them had chondrosarcoma and 1 of them had fibrosarcoma. Autografting were applied in 18 cases, autografting after liquid nitrogen in 1 case and bone transport after distraction osteogenesis were applied in 5 cases.
RESULTS: 14 of the patients were male,10 of them were female. The mean age was 18.6(5-42), follow-up period was 41.4 months (10-78) and bony defect was 10.7 cm (4-22). Mean MSTS scores was 77.3 reconstructed with bone transport and 74.5 undergone autografting. DASH score was 2.29(2.0-2.65), knee Society scores were 72.4(60-89) and the functional scores were 76.2 (65-91). There were nonunion in 3 cases undergone avascular fibulare grafting (%17.6) and 1 graft fracture. No neurovascular complication in any of the patients.Pin-tract infection was observed in 3 patients.
DISCUSSION AND CONCLUSION: One must avoid reconstructions that may affect the follow-up and treatment of the primary tumor when applying extremity-sparing surgery.Reconstruction with endoprosthesis must be the first-line option in the patients who are old,has high-grade tumor and has not treatment cooperation.On the other hand, for the patients with long survey with cooperation and ongoing bone development, biological reconstruction comes into prominence in terms of its regeneration providing nature with live bone tissue despite the shortcomings like nonunion, graft fracture and long treatment periods.In near future, we expect an increase in the use of biological reconstruction methods as some adjuvant factors that are facilitating union,graft hypertrophy and decreasing complications put into use.

Malign Kemik Tümörlerinde Biyolojik Rekonstrüksiyon

GÝRÝÞ ve AMAÇ: Malign kemik tümörleri cerrahisi sonrasý oluþan defektlerin giderilmesinde farklý rekonstrüksiyon yöntemleri kullanýlabilir. Bu çalýþmada primer malign kemik tümörleri cerrahisi sonrasý kemik defektlerinin biyolojik rekonstrüksiyon yöntemi ile tedavisini ve fonksiyonel sonuçlarýmýzý deðerlendirmeyi amaçladýk.
YÖNTEM ve GEREÇLER: 2003-2017 yýllarý arasý primer malign kemik tümörü nedeniyle biyolojik rekonstrüksiyon uygulanan 24 hasta çalýþmaya alýndý. Hastalarýn 11’i Ewing sarkom, 8’i osteosarkom, 2‘si malign dev hücreli tümör, 2’si kondrosarkom ve 1’i fibrosarkom tanýlý idi. 18 olguda otogreftleme,1 olguda adjuvan sývý nitrojen sonrasý otogreftleme ve 5 olguda distraksiyon osteogenezisi ile kemik transportu yöntemi kullanýldý.
BULGULAR: Hastalarýn 14’ü erkek,10’u kadýn olup ortalama yaþ 18.6(5-42), takip süresi 41.4 ay (10-78 ay) ve rezeksiyon sonrasý ortalama kemik defekti 10.7cm idi (4-22). Ortalama MSTS skorlarý kemik transportuyla rekonstrükte edilenlerde 77.3 ve otogreft uygulananlarda 74.5 olarak bulundu. Ortalama DASH skoru 2.29(2.0-2.65), Knee Society ortalama diz skorlarý 72.4(60-89) ve fonksiyon skorlarý 76.2 (65-91)idi. Avasküler fibuler greft uygulanan hastalardan 3’ünde kaynamama (%17.6),1’inde greft fraktürü görüldü. Hiçbir hastada nörovasküler komplikasyon görülmedi.3 hastada pin dibi enfeksiyonu görüldü.
TARTIÞMA ve SONUÇ: Ekstremite koruyucu cerrahi uygulanýrken primer tümörün takip ve tedavisini etkileyecek rekonstrüksiyonlardan kaçýnýlmalýdýr.Yaþlý,yüksek gradeli tümörü olan, tedavi kooperasyonu olmayan hastalarda modüler endoprotezlerle rekonstrüksiyon ilk tedavi seçeneðidir.Ancak kemik geliþimi tamamlanmamýþ,yaþam beklentisi uzun ve kooperasyonu tam hastalarda biyolojik rekonstrüksiyon;kaynamama,greft komplikasyonlarý ve uzun tedavi süreçleri gibi zorluklara raðmen canlý kemik dokusuyla rejenarasyon saðlamasý bakýmýndan ön plana çýkmaktadýr.Yakýn gelecekte kaynamayý ve greft hipertrofisini arttýrýcý,komplikasyonlarý azaltýcý adjuvan faktörlerin kullanýma girmesi ile biyolojik rekonstrüksiyon yöntemlerinin kullanýmýnýn artacaðýný düþünmekteyiz.