[Segmental allograft reconstruction in skeletal defect after limb tumor resection]

To study the clinical feasibility of the prosthetic composites of the intercalary allograft and the segmental allograft in reconstruction of the skeletal defect after the limb tumor resection.

Between August 1999 and December 2003, 28 patients with skeletal defects after the limb tumor resection were treated with the intercalary allograft or the segmental allograft megaprosthesis composite for reconstruction of skeletal defects. The bone involvements were observed in 16 patients with osteosarcoma, 4 patients with parosteal osteosarcoma, 5 patients with Ewing sarcoma, and 3 patients with soft tissue sarcoma. Preoperative biopsy was performed on all the patients, and the pathological result was confirmed after surgery. According to the Enneking system, 5 patients were grouped in I B and 23 patients in I B. The patients with osteosarcoma or Ewing sarcoma received the standard chemotherapy before and after operation. Eighteen and ten patients received the segmental allograft prosthetic composite replacement and the intercalary allograft with the interlocking intramedullary nail fixation, respectively. The functional outcome was evaluated by the MSTS score.

According to the follow-up for 5-48 months (average, 24 months), local recurrence was observed in 1 patient who underwent amputation eventually. Of the 28 patients, 3 developed nonunion of the allograft-host junction accompanied by severe resorption and 2 developed deep infection. No allograft fracture was seen in the patients. Most of the patients achieved a good functional result with an average MSTS score of 23. 4.

The prosthetic composite replacement of the intercalary allograft and the segmental allograft can be used in the skeletal defect reconstruction after the limb tumor resection. The stable contact in the allograft-host junction and the strong intramedullary internal fixation can help to reduce the complication rate of the allograft.