ALLOTRANSPLANTATION OF CRYOPRESERVATED VASCULARIZED BONE IN LIMB SALVAGE SURGERY FOR CHILDREN AND ADOLESCENTS WITH OSTEOSARCOMA_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

GUANJianzhong ,  ZHOUJiansheng , ZHOUXinshe , NIUGuoqi , WUMin , ZHANGChangchun , WANGZhiyan , GAOXubin , XIAOYuzhou

Department of Orthopaedics, the First Affiliated Hospital of Bengbu Medical College, Anhui Key Laboratory of Tissue Transplantation, Bengbu Anhui, 233000, P. R. China;

Corresponding author：

ZHOUJiansheng, Email: zhoujs12399@163.com

Keywords：

Cryopreservation; Allogenic bone; Vascularization; Bone transplantation; Osteosarcoma; Limb salvage surgery; Children; Adolescent

DOI：

10.7507/1002-1892.20150259

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Objective To investigate the effectiveness and technical key points of limb salvage surgery by allotransplantation of cryopreservated vascularized bone in children and adolescents with osteosarcoma. Methods A retrospective analysis was made on the clinical data of 21 children and adolescents with osteosarcoma receiving limb salvage surgery by allotransplantation of cryopreservated vascularized bone from their relatives between February 2004 and April 2012. There were 13 males and 8 females, aged from 7 to 16 years (mean, 12.6 years). According to Enneking stage system, 15 cases were rated as stage ⅡA and 6 cases as stage ⅡB. The tumors located at the distal femur in 10 cases, at the proximal femur in 1 case, at the proximal tibia in 8 cases, at the proximal humerus in 1 case, and at the distal radius in 1 case. Imaging examination showed that epiphyseal extension of malignant bone tumors in 7 cases. The iliac bone allograft with deep iliac vessels was obtained from their lineal consanguinity. After preservation by a twostep freezing schedule, the iliac bone allograft with deep iliac vessels was implanted into the bone defect area after tumor resection. The size of iliac bone flap was 8.0 cm×3.0 cm×2.0 cm-14.0 cm×5.0 cm×2.5 cm. Reserved joint surgery was performed on 16 cases and joint fusion surgery on 5 cases, and external fixation was used in all cases. The chemotherapy was given according to sequential high-dose methotraxate, adriamycin, and cisplatine before and after operation. Results All 21 cases were followed up from 5 months to 11 years (mean, 6.4 years). At 2 weeks after operation, the erythrocyte rosette forming cells accounted for 56.7%±3.9%, showing no significant difference when compared with that of normal control (58.3%±4.3%) (t=1.56, P=0.13), which suggested no acute rejection. At 4 weeks after operation, single photon emission computerized tomography bone scan indicated that the blood supply of bone graft was rich, and the metabolism was active. At 12 weeks after operation, the digital subtraction angiography showed the artery of iliac bone flap kept patency. X-ray films showed that malunion and non-union occurred at 5 and 6 months after operation in 1 case, respectively. The bone graft healed in the other patients, and the healing time was 3.2-6.0 months (mean, 4.4 months). At last follow-up, American Musculoskeletal Tumor Society (MSTS) score was significantly improved to 26.80±2.14 from preoperative value (17.15±1.86) (t=-4.15, P=0.00). The survival rate was 85.7% (18/21) and the recurrence rate was 9.5% (2/21). Conclusion Allotransplantation of cryopreservated vascularized bone from the relatives provides a new method for the treatment of osteosarcoma in children and adolescents. A combination of allotransplantation and chemotherapy can achieve the ideal treatment effect. The correct cutting, preservation, and transplantation of the donor bone, and indication are the key to improve the effectiveness.

Citation： GUANJianzhong, ZHOUJiansheng, ZHOUXinshe, NIUGuoqi, WUMin, ZHANGChangchun, WANGZhiyan, GAOXubin, XIAOYuzhou. ALLOTRANSPLANTATION OF CRYOPRESERVATED VASCULARIZED BONE IN LIMB SALVAGE SURGERY FOR CHILDREN AND ADOLESCENTS WITH OSTEOSARCOMA. Chinese Journal of Reparative and Reconstructive Surgery, 2015, 29(10): 1189-1193. doi: 10.7507/1002-1892.20150259 Copy

1.	Ruggieri P, Mavrogenis AF, Pala E, et al. Outcome of expandable prostheses in children. J Pediatr Orthop, 2013, 33(3):244-253.
2.	Squire G, Grundy TJ, Ferran NA, et al. Long-term survival of proximal humerus allografts for reconstruction following resection of malignant bone tumours. Acta Orthop Belg, 2013, 79(3):260-265.
3.	Henderson ER, Pepper AM, Marulanda G, et al. Outcome of lowerlimb preservation with an expandable endoprosthesis after bone tumor resection in children. J Bone Joint Surg (Am), 2012, 94(6): 537-547.
4.	Sugiura H, Nishida Y, Nakashima H, et al. Evaluation of long-term outcomes of pasteurized autografts in limb salvage surgeries for bone and soft tissue sarcomas. Arch Orthop Trauma Surg, 2012, 132(12):1685-1695.
5.	杨志明, 饶书城, 项舟, 等. 吻合血管同种异体肱骨干移植20年随访结果. 中国修复重建外科杂志, 2001, 15(6):354-357.
6.	周建生, 胡汝麒, 潘功平, 等. 吻合血管的同种异体肋骨移植实验研究. 中国修复重建外科杂志, 1996, 10(4):210-213.
7.	谢波, 周建生. 骨肉瘤侵袭范围的MRI测量与确定合理切除平面的相关研究. 中国骨肿瘤骨病, 2008, 7(1):14-18.
8.	D'Adamo DR. Appraising the current role of chemotherapy for the treatment of sarcoma. Semin Oncol, 2011, 38 Suppl 3:519-529.
9.	Saghieh S, Abboud MR, Muwakkit SA, et al. Seven-year experience of using Repiphysis expandable prosthesis in children with bone tumors. Pediatr Orthop Pediatr Blood Cancer, 2010, 55(3):457-463.
10.	Abed R, Grimer R. Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev, 2010, 36(4):342-347.
11.	Hwang N, Grimer RJ, Carter SR, et al. Early results of a non-invasive extendible prosthesis for limb-salvage surgery in children with bone tumours. J Bone Joint Surg (Br), 2012, 94(2):265-269.
12.	Picardo NE, Blunn GW, Shekkeris AS, et al. The medium-term results of the Stanmore non-invasive extendible endoprosthesis in the treatment of ediatric bone tumours. J Bone Joint Surg (Br), 2012, 94(3):425-430.
13.	周建生, 刘岗, 胡汝麒, 等. 冷冻保存对带血管异体骨关节移植排斥反应的影响实验研究. 中华显微外科杂志, 2000, 23(1):52-54.
14.	周建生, 郑圣鼐, 潘功平, 等. 带血管鼠膝关节冷冻保存研究. 中国临床解剖学杂志, 2000, 16(2):172-176.
15.	Liu T, Liu ZY, Zhang Q, et al. Hemicortical resection and reconstruction using pasteurised autograft for parosteal osteosarcoma of the distal femur. Bone Joint J, 2013, 95-B(9):1275-1279.
16.	周建生, 叶永杰, 苗华. 膝周血管的应用解剖与骨肿瘤保肢术受区血管的选择. 解剖与临床, 2004, 9(3):137-141.

1. Ruggieri P, Mavrogenis AF, Pala E, et al. Outcome of expandable prostheses in children. J Pediatr Orthop, 2013, 33(3):244-253.
2. Squire G, Grundy TJ, Ferran NA, et al. Long-term survival of proximal humerus allografts for reconstruction following resection of malignant bone tumours. Acta Orthop Belg, 2013, 79(3):260-265.
3. Henderson ER, Pepper AM, Marulanda G, et al. Outcome of lowerlimb preservation with an expandable endoprosthesis after bone tumor resection in children. J Bone Joint Surg (Am), 2012, 94(6): 537-547.
4. Sugiura H, Nishida Y, Nakashima H, et al. Evaluation of long-term outcomes of pasteurized autografts in limb salvage surgeries for bone and soft tissue sarcomas. Arch Orthop Trauma Surg, 2012, 132(12):1685-1695.
5. 杨志明, 饶书城, 项舟, 等. 吻合血管同种异体肱骨干移植20年随访结果. 中国修复重建外科杂志, 2001, 15(6):354-357.
6. 周建生, 胡汝麒, 潘功平, 等. 吻合血管的同种异体肋骨移植实验研究. 中国修复重建外科杂志, 1996, 10(4):210-213.
7. 谢波, 周建生. 骨肉瘤侵袭范围的MRI测量与确定合理切除平面的相关研究. 中国骨肿瘤骨病, 2008, 7(1):14-18.
8. D'Adamo DR. Appraising the current role of chemotherapy for the treatment of sarcoma. Semin Oncol, 2011, 38 Suppl 3:519-529.
9. Saghieh S, Abboud MR, Muwakkit SA, et al. Seven-year experience of using Repiphysis expandable prosthesis in children with bone tumors. Pediatr Orthop Pediatr Blood Cancer, 2010, 55(3):457-463.
10. Abed R, Grimer R. Surgical modalities in the treatment of bone sarcoma in children. Cancer Treat Rev, 2010, 36(4):342-347.
11. Hwang N, Grimer RJ, Carter SR, et al. Early results of a non-invasive extendible prosthesis for limb-salvage surgery in children with bone tumours. J Bone Joint Surg (Br), 2012, 94(2):265-269.
12. Picardo NE, Blunn GW, Shekkeris AS, et al. The medium-term results of the Stanmore non-invasive extendible endoprosthesis in the treatment of ediatric bone tumours. J Bone Joint Surg (Br), 2012, 94(3):425-430.
13. 周建生, 刘岗, 胡汝麒, 等. 冷冻保存对带血管异体骨关节移植排斥反应的影响实验研究. 中华显微外科杂志, 2000, 23(1):52-54.
14. 周建生, 郑圣鼐, 潘功平, 等. 带血管鼠膝关节冷冻保存研究. 中国临床解剖学杂志, 2000, 16(2):172-176.
15. Liu T, Liu ZY, Zhang Q, et al. Hemicortical resection and reconstruction using pasteurised autograft for parosteal osteosarcoma of the distal femur. Bone Joint J, 2013, 95-B(9):1275-1279.
16. 周建生, 叶永杰, 苗华. 膝周血管的应用解剖与骨肿瘤保肢术受区血管的选择. 解剖与临床, 2004, 9(3):137-141.

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Chinese Journal of Reparative and Reconstructive Surgery

ALLOTRANSPLANTATION OF CRYOPRESERVATED VASCULARIZED BONE IN LIMB SALVAGE SURGERY FOR CHILDREN AND ADOLESCENTS WITH OSTEOSARCOMA

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