Vascularized fibula autograft combined bone graft for reconstruction of femoral shaft continuity after resection of malignant tumor / 中华骨科杂志

ABSTRACT

Objective:To investigate the effects of parallel reconstruction with titanium cable fixation and concentric reconstruction with plate fixation in the reconstruction of femoral shaft continuity after resection of malignant tumor.Methods:From September 2013 to December 2017, the data of 11 consecutive patients with thigh malignancies and related complications were retrospectively analyzed, including 10 males and 1 female. The mean age of the 11 patients was 27.1±15.6 years (range, 7-49 years). These case series included 6 cases of primary bone defect reconstruction after resection of femoral shaft malignant tumor, 4 cases of nonunion or allogeneic bone fracture after massive bone allograft for femoral malignant tumor, and 1 case of femoral fracture caused by radiotherapy after resection of thigh soft tissue sarcoma. Vascularized fibular autograft combined with massive bone allograft or devitalized bone graft was used for reconstruction. The patients were divided into two groups according to reconstruction method, namely parallel reconstruction group and concentric reconstruction group. In the parallel reconstruction group, the vascularized fibula was placed on the medial side of the femur and the allograft and fixed with titanium cable. In the concentric reconstruction group, the vascularized fibula was placed in the medullary cavity of the allogeneic bone or devitalized bone and further fixed with the plate and screws.Results:There were 5 patients with 7 allograft-host junctions or fracture were treated with parallel reconstruction. The grafted length of fibula was 15.0±4.3 cm (range, 10-20 cm). The follow-up duration was 33.2±15.6 months (range, 20-53 months). Six patients with 10 allograft-host junctions were treated by concentric reconstruction. The grafted length of fibula was 15.5±2.3 cm (range, 12-18 cm). The follow-up duration was 45.8±15.3 months (range, 22-62 months). There was no significant difference during follow-up between the two groups ( t=1.36, P=0.208). The union rate in parallel reconstruction group was 100% (7/7), and the union duration was 15.9±6.8 months (range, 3-22 months). The union rate in the concentric reconstruction group was 70% (7/10), and the union duration was 18.9±6.4 months (range, 11-30 months). There was no significant difference in the union rate ( P=0.228) or the union duration ( t=0.846, P=0.414) between the two groups. Conclusion:Both parallel reconstruction and concentric reconstruction of vascularized fibular autograft are important methods for reconstruction of femoral shaft continuity after resection of malignant tumor. There might be no significant difference in union rate or union duration between the two methods.