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骨科动态 2006年第2期2卷 87-92页

作者： PIERRE-LOUIS DOCQUIER christian delloye 韩岳（译） Investigation performed at Cliniques Universitaires St-Luc Brussels Belgium 天津医院脊柱外科 300211

背景：在假设动脉瘤样骨囊肿通过内部骨化存在自愈潜能的基础上，发展出一种新的、微创的治疗动脉瘤样骨囊肿方法。即用脱矿物质骨粉混合自体骨髓注入骨囊肿内，从而使病变停止进展，并自行骨化。我们提出假设，即为了诱导骨质愈合。骨... 详细信息

背景：在假设动脉瘤样骨囊肿通过内部骨化存在自愈潜能的基础上，发展出一种新的、微创的治疗动脉瘤样骨囊肿方法。即用脱矿物质骨粉混合自体骨髓注入骨囊肿内，从而使病变停止进展，并自行骨化。我们提出假设，即为了诱导骨质愈合。骨囊肿细胞只需要对诱导材料的作用产生反应，而囊肿刮除术或扩大的外科手术是不必要的。此项研究的目的在于评估这种新方法对于骨囊肿的治愈情况，及其治疗本病的复发率的因素。方法：对13例经活检确诊为动脉瘤样骨囊肿的患者，经小切口向病灶内注入脱矿物质骨和自体骨髓混合骨泥。研究组中男3例，女10例，平均年龄16．6岁。病灶部位位于长骨者6例，骨盆5例，位于肩关节盂和跟骨者各1例。其中5例患者既往未经任何治疗，1例经术前栓塞，其余7例患者为治疗后复发者。结果：经过平均3．9年的随访，其中11例患者获得治愈。结论：该微创方法能够促进原发性动脉瘤样骨囊肿自愈。采用该治疗方法不再需要进行刮除术。能够避免过大的外科手术及失血，并且对于位于类似骨盆这样不容易暴露部位的病灶，可以使操作更为便捷。

关键词：动脉瘤样骨囊肿自体骨髓脱钙骨注射外科手术平均年龄骨质愈合诱导材料病灶部位

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Shoulder Reconstruction with Massive Scapular-Proximal Humerus Osteoarticular Allograft after Total Scapulectomy for Proximal Humerus Osteosarcoma Recurrence

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Open Journal of Orthopedics 2015年第12期5卷 390-399页

作者： Alidou Traoré Karim Tribak Brahima Doukouré Daouda Kanaté Soumaro Slim Alban Mbende Sidi Yaya Traoré Rebecca Eva Boka christian delloye Trauma and Orthopaedic Unit Yopougon Teaching Hospital Abidjan Cote d’Ivoire St-Luc University Clinics (UCL) Brussels Belgium Department of Pathology Cocody Teaching Hospital Abidjan Cote d’Ivoire Neurosurgery Unit Yopougon Teaching Hospital Abidjan Cote d’Ivoire

Bone tumors are infrequent within the scapula. Total scapulectomy with massive allograft reconstruction represents an attractive alternative to amputation when the whole scapula is invaded with tumor and the neurovascular bundle can be preserved during tumor resection. We report a case of resection of the scapula and proximal humerus for recurrent osteosarcoma with massive allograft reconstruction of the scapula and proximal humerus. A 22-year-old male patient was seen in February 1992 for a pathological fracture of the proximal left humerus. In July 1992, a resection of the proximal end of the humerus followed by a reconstruction with osteochondral allograft and nail osteosynthesis was performed. The postoperative course was uneventful. In September 2009, 17 years later, the patient presented with a huge tumor developed at the level of the scapula. There was no vascular or neurological symptom. Plain radiography showed an expansive osteolytic mass. CT scan demonstrated scapular and proximal humerus invasion. An extended assessment revealed the presence of two pulmonary nodules. The biopsy confirmed the recurrence of osteosarcoma. The indication of a resection of both the left scapula and the 1992 allograft which was completely invaded at its proximal portion and the complete reconstruction of the scapula and the proximal humerus with allograft was made. One year postoperatively, we note a favourable outcome in terms of musculoskeletal functions. Despite two resection surgeries of pulmonary nodules and chemotherapy treatments, the patient developed new lung metastases and an unfavourable outcome. Although shoulder function was almost completely eliminated following surgery, preservation of elbow, wrist and finger motion resulted in an acceptable level of postoperative limb function. This reconstruction appears to be an attractive technique to be used in similar cases. The necessity of a reliable tissue bank with quality allografts in sufficient number is paramount.

关键词： Osteosarcoma Scapula Proximal Humerus Allograft

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Proximal Femoral Allograft in Two-Stage Revision for Failed Septic Hip Arthroplasty

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Open Journal of Orthopedics 2015年第12期5卷 379-389页

作者： Alidou Traore Karim Tribak Jeancis Be Maité Van Cauter Christelle Mobiot-Aka Yaya Sidi Traoré Slim Alban Mbende Daouda Kanaté Soumaro Rebecca Eva Boka Jean Cyr Yombi christian delloye Olivier Cornu Trauma and Orthopaedic Unit Yopougon Teaching Hospital Abidjan Cote d’Ivoire St-Luc University Clinics (UCL) Brussels Belgium Neurosurgery Unit Yopougon Teaching Hospital Abidjan Cote d’Ivoire

Infection after hip prostheses is a potentially devastating complication, and a serious medical and surgical challenge, especially when associated with Paprosky type III femoral bone loosening. Treatment is difficult and options are limited. We report on a 2-stage revision of 15 patients undergoing femur reconstruction with massive allografts. Materials and methods: This was a prospective study which included 15 patients (10 men and 5 women) with infected hip prosthesis, associated with Paprosky type III femoral proximal massive bone loss. The median age of patients was 64 years with a preoperative functional status score of 6. The average number of procedures to the same hip after the first arthroplasty was 6. All patients benefited from a 2-step surgery with massive allografts and locking prosthesis. The average follow-up time was 36 months. Results: Infection was monomicrobial in 14 cases;and was polymicrobial in 4 cases. Methicillin-resistant Staphylococcus epidermidis was the main bacteria (n = 10). The average C-reactive protein level before the second procedure was 2.3 ± 3.4. It was normalized in 8 cases. We recorded 13 cases of primary consolidation without another surgery, 3 cases of relapse, 2 traumatic dislocations and 2 fractures of the allograft. Conclusion: Hip prosthesis infection is a potentially catastrophic complication with significant negative ramifications for both the patient and the healthcare system. Massive allografts use in Paprosky III femoral defect remains very attractive for bone stock restoration and hip function improvement.

关键词： Arthroplasty Hip Infection Femur Paprosky 3 Massive Allograft

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