학술논문
Distraction Osteogenesis Reconstruction Following Resection of Bone Sarcomas: Surgical, Functional, and Oncological Outcomes from a Prospective Trial Analysis.
Document Type
Academic Journal
Author
Bozzo A; Orthopaedic Service of the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.; Orthopedic Oncology, McGill University, Montreal, Canada.; Aysola V; Orthopaedic Service of the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.; Yeung CM; Orthopaedic Service of the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.; Healey JH; Orthopaedic Service of the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.; Prince DE; Orthopaedic Service of the Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY.
Source
Publisher: Journal of Bone and Joint Surgery Country of Publication: United States NLM ID: 0014030 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1535-1386 (Electronic) Linking ISSN: 00219355 NLM ISO Abbreviation: J Bone Joint Surg Am Subsets: MEDLINE
Subject
Language
English
Abstract
Background: While sustainable long-term function has been established for biological reconstruction with distraction osteogenesis (DO) following osseous resections, there is a paucity of published data informing surgeons and patients on important milestones in the reconstructive process. The objectives of this study were to determine when to expect complete bone healing and full weight-bearing as well as to quantify the influence of chemotherapy on the osseous regeneration process.
Methods: Prospectively, pathological and clinical data were collected for 30 consecutive patients who underwent primary or secondary DO-based reconstruction following osseous resection from 2018 to 2021. Serial radiographs indicated the times to cortex formation and full union. An unpaired t test was used to compare the time required for full bone remodeling of segments transported with and without concurrent chemotherapy.
Results: The average resection length was 13.6 cm (range, 4 to 22 cm). Patients underwent an average of 6.1 procedures (range, 1 to 14 procedures). Half (50%) of all procedures were planned, while half were unplanned procedures. All patients achieved full, independent weight-bearing at a median of 12 months (interquartile range [IQR], 9 to 16 months). For the 34 segments transported concurrently with chemotherapy, the mean bone healing index (BHI) was 2.3 ± 0.7, and the mean BHI was 1.2 ± 0.4 for the 25 segments without chemotherapy at any point during their transport (p < 0.0001).
Conclusions: All 30 patients achieved full bone healing and independent weight-bearing at a median of 1 year postoperatively and continued to show functional improvement afterward. Surgeons and patients can expect bone healing to be nearly twice as fast for segments transported after completion of systemic chemotherapy compared with segments transported concurrently with adjuvant chemotherapy.
Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Competing Interests: Disclosure: This work was supported by National Institutes of Health/National Cancer Institute Cancer Center Support Grant, (P30 CA008748). The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I11).
(Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)
Methods: Prospectively, pathological and clinical data were collected for 30 consecutive patients who underwent primary or secondary DO-based reconstruction following osseous resection from 2018 to 2021. Serial radiographs indicated the times to cortex formation and full union. An unpaired t test was used to compare the time required for full bone remodeling of segments transported with and without concurrent chemotherapy.
Results: The average resection length was 13.6 cm (range, 4 to 22 cm). Patients underwent an average of 6.1 procedures (range, 1 to 14 procedures). Half (50%) of all procedures were planned, while half were unplanned procedures. All patients achieved full, independent weight-bearing at a median of 12 months (interquartile range [IQR], 9 to 16 months). For the 34 segments transported concurrently with chemotherapy, the mean bone healing index (BHI) was 2.3 ± 0.7, and the mean BHI was 1.2 ± 0.4 for the 25 segments without chemotherapy at any point during their transport (p < 0.0001).
Conclusions: All 30 patients achieved full bone healing and independent weight-bearing at a median of 1 year postoperatively and continued to show functional improvement afterward. Surgeons and patients can expect bone healing to be nearly twice as fast for segments transported after completion of systemic chemotherapy compared with segments transported concurrently with adjuvant chemotherapy.
Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
Competing Interests: Disclosure: This work was supported by National Institutes of Health/National Cancer Institute Cancer Center Support Grant, (P30 CA008748). The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJS/I11).
(Copyright © 2024 by The Journal of Bone and Joint Surgery, Incorporated.)