대한골관절종양학회지 (The Journal of the Korean bone and joint tumor society)

  • 제16권1호
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  • Pages.1-7
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  • 2010
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  • 1226-4962(pISSN)
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  • 2233-9841(eISSN)
대한근골격종양학회 (The Korean Musculoskeletal Tumor Society)
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사지 골육종에서 체외 방사선 조사를 이용한 재건술

The Reconstruction with Extracorporeal Irradiated Autograft for Osteosarcoma of Extremities

  • 김재도 (고신대학교 복음병원 정형외과) ;
  • 이근우 (고신대학교 복음병원 정형외과) ;
  • 정소학 (고신대학교 복음병원 정형외과)
  • Kim, Jae-Do (Department of Orthopedic Surgery, Kosin University Gospel Hospital) ;
  • Lee, Gun-Woo (Department of Orthopedic Surgery, Kosin University Gospel Hospital) ;
  • Chung, So-Hak (Department of Orthopedic Surgery, Kosin University Gospel Hospital)
  • 투고 : 2010.03.30
  • 심사 : 2010.05.20
  • 발행 : 2010.06.30
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초록

목적: 체외 방사선 조사를 이용한 재활용 자가골 이식술의 추시 결과를 생존, 기능적 결과, 합병증의 측면에서 알아보고자 한다. 대상 및 방법: 1995년 1월부터 2006년 7월까지 골육종으로 진단받고, 체외 방사선 조사를 이용한 재활용 자가골 이식술을 시행한 31예를 대상으로 하였으며, 추시 기간은 평균 117개월(17-177개월)이었다. 남자 24예, 여자 7예 였으며 평균 나이는 24세(7-74세)였다. 절제 방법으로 골연골절제 18예, 분절절제 6예, 전관절절제 5예, 조각절제 2예였다. 재건 방법으로 체외방사선 조사를 시행한 자가골 이식군이 25예, 자가골-종양대치물 복합체군이 6예였다. 병리학적 분류 상 중심성 29예, 골막성 1예, 방골성 1예였다. 골육종의 부위는 원위 대퇴골 15예, 근위 비골, 상완골 및 근위 경골 각 3예, 원위 대퇴골, 원위 경골 및 골반골 각 2예, 종골 1예였다. 술 후 기능적 평가를 위해 MSTS Score를 이용하였으며, 생존율 및 국소 재발, 합병증에 대해 분석하였다. 결과: 생존율은 80.6%였고, 무병 생존율은 64.5%였다. 총 9예에서 원격 전이가 있었고, 이 중 5예에서 사망하였다. 국소 재발로 인해 1예에서 무릎위 절단술을 시행하였다. 총 31예 중 23예, 74.1%에서 합병증이 발생되었다. 불유합 7예, 심부 감염 5예, 관절 불안정성 4예, 금속물 문제 2예, 사지 부동(LLD) 2예, 금속물 주위 골절 1예, 골단판 붕괴 1예, 국소 재발 1예였다. MSTS score를 이용한 술 후 기능 평가에서는 평균 62.5%였다. 결론: 체외 방사선 조사를 이용한 자가골 이식은 종양학적, 술 후 기능적 측면에서 비교적 양호한 결과를 얻을 수 있으나, 많은 합병증이 발생하였다. 분절 절제 및 조각 절제 이후 체외 방사선 조사를 이용한 재건술은 종양학적, 술 후 기능적, 합병증 발생 면에서 효과적인 방법이라고 판단된다.

Purpose: With advances in various treatment modalities, limb salvage surgery has been commonly used in osteosarcoma of extremities. An alternative method for skeletal reconstruction is reimplantation of the tumor bearing bone following extracorporeal irradiation (ECI). We report the long-term results of ECI autograft in aspect of the oncological and functional outcomes, and complications. Materials and Methods: We retrospectively reviewed 31 osteosarcoma patients who underwent reconstruction with ECI between July 1995 and January 2006. There were 24 males and 7 females with a mean age of 24 (7-74 years) and a mean follow-up of 117 months (17-177 months). Twenty-five cases were reconstructed with ECI autograft, 6 cases with ECI autograft-prosthesis composite. The pathologic subtypes were conventional in 29 cases, periosteal in 1 case, and parosteal in 1 case. The most common location of tumor was distal femur (15 cases) followed by humerus (3), proximal fibula (3) and proximal tibia (3). Musculoskeletal Tumor Society (MSTS) score was used for functional evaluation. The overall survival rate, local recurrence, complications were analyzed. Results: The overall survival rate was 80.6% and the disease-free survival rate was 64.5%. Five patients died of distant metastasis. One patient required above-knee amputation due to local recurrence. All of them, twenty-three complications occurred, which included nonunion in 7 cases, deep infection in 5 cases, joint instability in 4 cases, metal failure in 2 cases, Limb-length discrepancy (LLD) in 2 cases, periprosthetic fracture in 1 case, epiphyseal collapse in 1, local recurrence in 1 case. The mean MSTS functional score was 62.5%. Conclusion: Extracorporeal irradiated autograft can be achieved relatively good result in aspect of oncological and functional aspect, but is needed to be additional research about occurring many complications. The reconstruction with ECI after intercalary or fragmentary resection is effective reconstruction in aspect of oncological and functional result, complications.

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참고문헌

  1. Lee SY, Jeon DG, Lee JS, Oh HO, Jung DH. Survival of Stage IIB Osteosarcoma - Limb-salvage Vs Amputation -. J of Korean Orthop Assoc. 1994;29:1308-15.
  2. Hong A, Steven G, Stalley P, et al. Extracorporeal irradiation for malignant bone tumors. Int J Radiation Oncology Biol Phys. 2001;50:441-7. https://doi.org/10.1016/S0360-3016(01)01460-2
  3. SH Chung, Cho Y, Kim JD. Recycling total joint autotransplantation in osteosarcoma around knee joint. J of Korean Bone Joint Tumor. 2007;13:31-6.
  4. Enneking WF, Dunham W, Gebhardt MC, Malawar M, Pritchard DJ. A system for the functional evaluation of reconstruc tive procedures aft er surgical treatment of tumors of the musculoskeletal system. Clin Orthop Relat Res. 1993;286:241-6.
  5. Johnston JO. Local resection in primary maliganat bone tumors. Clin Orthop Relat Res. 1980;153:73-80.
  6. Salzer M, Knahr K, Kotz R, Ramach W. Cementless prosthetic implants for limb salvage of malignant tumors of the knee joint: clinical results of three modes of anchorage. In: Ennecking WF, ed. Limb salvage in musculoskeletal oncology. New York: Churchill Livingstone; 1987. 26-9.
  7. Malawer MM, Chou LB. Prosthetic survival and clinical results with use of large-segment replacements in the treatment of high-grade bone sarcomas. J Bone Joint Surg Am. 1995;77:1154-65. https://doi.org/10.2106/00004623-199508000-00003
  8. Dick HM, Malinin TI, Mnaymn WA. Massive allograft implantations following radical resection of high-grade tumors requiring adjuvant chemotherapy treatment. Clin Orthop Relat Res. 1985;197:88-95.
  9. Enneking WF, Mindell ER. Observations on massive retrieved human allograft s. J Bone Joint Surg. 1991;73:1123-42. https://doi.org/10.2106/00004623-199173080-00002
  10. Jensen KL, Johnston JO. Proximal humeral reconstruction after excision of a primary sarcoma. Clin Orthop Relat Res. 1987;218:247-58.
  11. Kohler P, Kreicberg A. Chondrosarcoma treated by reimplantation of resected bone aft er autoclaving and supplement with allogenic bone matrix. Clin Orthop Relat Res. 1993;294:281-4.
  12. Manabe J. Experimental studies on pasteurized autogenous bone graft . J Jpn Orthop Assoc. 1993;67:255-66.
  13. Manabe J, Kawaguchi N, Matsumoto S, Kuroda H. Limb salvage and reconstruction by pasteurized autogenous bone graft . J Jpn Orthop Assoc. 1993;67:21-3.
  14. Hurson BJ. Limb sparing surgery for patients with sarcomas [editorial]. J Bone Joint Surg Br. 1995;77:173-4.
  15. Shinobu T, Masayki S, Yoshimoto K, et al. Long-lasting tolerance of articular cartilage after experimental intraopera tive radiation in rabbits. Clin Orthop Relat Res. 1992;275:300-5.
  16. Sugimoto M, Takahashi S, Toguchida J, Kotoura Y, Shibamoto Y, Yamamuro T. Changes in bone aft er high-dose radiation. J Bone Joint Surg. 1991;73:492-7.
  17. Spira E, Brenner HT, Lubin E. Extracorporeal irradiation of malignant bone tumors. In: Chapchal G, ed. Operative treatment of bone tumors. Stuttgart: Thieme; 1970. 136-40.
  18. Chen WM, Chen TH, Huang CK, Chiang CC, Lo WH. Treatment of malignant bone tumors by extracorporeal irradiated autograft -prosthetic composite arthroplasty. J Bone Joint Surg. 2002;84:1156-61. https://doi.org/10.1302/0301-620X.84B8.13508
  19. Bohm P, Fritz J, Th iede S, Budach W. Reimplantation of extracorporeal irradiated bone segments in musculoskeletal tumor surgery: clinical experience in eight patients and review of the literature. Langenbecks Arch Surg. 2003;387:355-65.
  20. Uyttendaele D, Schryver AD, Claessens H. Limb conservation in primary bone tumors by resection, extracoporeal irradiation and re-implantation. J Bone Joint Surg. 1988;70:348-53.
  21. Takahashi S, Sugimoto M, Kotoura Y, et al. Long standing toler ance of articular cartilage aft er experimenral intraoperative radiation in rabbits. Clin Orthop Relat Res. 1992;275: 300-5.
  22. Sabo D, Bernd L, Ewerbeck V, Eble M, Wannenmacher M, Schulte M. Lokal Behandlung primar maligner Knochentumor en. Intraoperative extrakorporale Bestrahlung und Replan tation. Unfallchirurg. 1999;102:580-8. https://doi.org/10.1007/s001130050453
  23. Tsuboyama T, Toguchida J, Kotoura Y, Kasahara K, Hiraoka M, Nakamura T. Intra-operative radiation therapy for osteo sarcoma in the extremities. International Orthopaedics (SICOT). 2000;24:202-7. https://doi.org/10.1007/s002640000154