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There are various methods for bone plate reconstruction after bone tumor resection. The following are some common and effective methods:
Autologous bone grafting: Commonly used are vascularized and vascularized fibular grafts. Vascularized fibular transplantation is simple to operate. For those with bone defects larger than 7cm, pedunculated fibular transplantation is recommended. Since its use began in the 1970s, vascularized fibular flap transplantation has been widely applied in the reconstruction of long bone defects in tumor limb salvage surgery. It can significantly improve the therapeutic effect of limb bone tumors, with short bone healing time and fewer postoperative complications.
Allogeneic bone grafting: Allogeneic bone grafting is an effective method for treating bone defects after limb tumor surgery. Its good bone healing is achieved through stable internal fixation and precise matching of the donor contact surface with the osteotomy surface. However, the source of allogeneic bone is limited. It is somewhat difficult to reconstruct large bone defects with simple allogeneic bone. Moreover, within 2 to 3 years after reconstruction, infection is the most common cause for the removal of allogeneic bone.
Tumor bone inactivation and reimplantation: Tumor bone is inactivated through various means and then reimplanted at the original site. Currently, commonly used inactivation methods in clinical practice include radiation irradiation, liquid nitrogen cryopreservation inactivation, constant temperature of 65° C, and inactivation with 10% hypertonic saline for 30 minutes, etc. Inactivated tumor bone replantation and bone end can achieve stable bony healing. Existing reports have shown good postoperative effects and high safety. However, this treatment method also has a certain recurrence rate and postoperative complication rate. Common complications include nonunion of bone, bone collapse, etc. After inactivation, the bone strength decreases, and there is a risk of fracture.
Masquelet technique: Developed by ACMasquelet in the 1970s, it is a two-stage bone reconstruction technique. In the first stage, after bone tumor resection, internal fixation was performed to stabilize the bone ends. Polymethyl methacrylate spacers were administered for bone defect treatment. Subsequently, an inflammatory response occurred, accompanied by inflammatory cell infiltration and edema, gradually forming an induced membrane. In the second stage, the spacer is removed and autologous cancellous bone is implanted into the induction membrane to repair the bone defect.
Bone transport and lengthening surgery: By pulling the osteotomy segment towards the bone defect to induce normal bone tissue regeneration, it can fill large bone defects. It is one of the limb salvage treatment methods for bone malignant tumors. Through this surgical approach, biological reconstruction can be achieved and a better long-term prognosis can be obtained. However, IIizarov is generally used for relocation. Postoperative care is difficult, the treatment cycle is long, and there is a risk of nail tract infection.
Artificial prosthesis replacement: After limb salvage treatment for periarticular tumors, bone defect reconstruction mainly adopts artificial tumor-type prosthesis replacement, which can enable patients to obtain early stable joints, satisfactory appearance and good joint functional activities. However, deep infection of the prosthesis is one of the most serious complications of tumor-type prostheses, and deep infection can lead to the failure of prosthesis replacement.
3D printed implant reconstruction: 3D printing manufacturing technology can effectively conformal match the morphology of bone defects after bone tumor resection, and can promote prosthesis and bone integration through the special manufacturing technology of the prosthesis and bone contact surface. 3D printing can fabricate complex-shaped implants with porous structures. Porous scaffolds allow the growth of host bone within the implant to achieve stable reconstruction and reduce the risk of mismatch between allogeneic bone/adaptive prosthesis and the host osteotomy site.