Survival and functional outcomes following the use of an isolated, liquid nitrogen-treated, devitalized autograft after femoral intercalary resection in patients with bone sarcomas

Abstract

Objective: This study aimed to evaluate the clinical and functional outcomes of femoral diaphyseal sarcoma resections reconstructed using liquid nitrogen-treated tumor-bearing autografts filled with antibiotic-impregnated polymethylmethacrylate, locked intramedullary nailing with proximal and distal derotation plating, and docking-site grafting. Methods: Between 2004 and 2023, nine patients who underwent femoral diaphyseal resection for osteosarcoma, Ewing’s sarcoma, and small cell sarcoma were retrospectively reviewed. In all cases, tumor-bearing bone segments were devitalized using standardized liquid nitrogen protocol, followed by reimplantation with reconstruction-type intramedullary nailing without incorporating a vascularized graft. A detailed evaluation of postoperative clinical, radiological, and functional outcomes was conducted. Functional outcomes were assessed using the Musculoskeletal Tumor Society Score. Results: The study included nine patients with a mean age of 18.6 years, of whom four were male, five were female. The mean follow-up period was 6.55 years. The mean tumor size was 14.4 cm. Timely union occurred in six patients, while two experienced delayed union and one had nonunion, all of which ultimately healed with or without reintervention. No local or systemic infections, graft fractures, or implant failure were observed. At final follow-up, five patients were disease-free, three were alive with the disease, and one died of the disease. The mean MSTS score was 89.5. Conclusions: Liquid nitrogen-treated autografts offer a safe, cost-effective, and biologically favorable reconstruction option for femoral diaphyseal sarcomas, particularly in young patients with adequate soft tissue coverage. When applied with a standardized technique and careful augmentation, this method results in favorable union rates and long-term functional outcomes.

Keywords

• biological reconstruction
• liquid nitrogen
• bone union
• osteosarcoma
• limb salvage

Kemik sarkom olan hastalarda femoral interkalar rezeksiyon sonrası izole, sıvı nitrojenle tedavi edilen, devitalize edilmiş otogreftin kullanımından sonra sağkalım ve fonksiyonel sonuçlar

Abstract

Amaç: Bu çalışmada, antibiyotik emdirilmiş polimetilmetakrilat (PMMA) dolgulu, sıvı nitrojenle muamele edilmiş tümör taşıyan otogreftler yardımıyla, proksimal ve distal derotasyon plaklamalı kilitli intramedüller çivileme yapılıp otogreft yerleştirilmesi ile rekonstrükte edilen femoral diafiz sarkomu rezeksiyonlarında klinik ve fonksiyonel sonuçların değerlendirilmesi amaçlanmıştır. Yöntemler: 2004-2023 yılları arasında osteosarkom (n=5), Ewing sarkomu (n=3) ve küçük hücreli sarkom (n=1) nedeniyle femoral diafiz rezeksiyonu geçiren dokuz hasta retrospektif olarak incelendi. Tüm olgularda, tümör taşıyan kemik segmentleri standart sıvı nitrojen protokolü kullanılarak devitalize edildi ve ardından vaskülarize greft kullanılmadan rekonstrüksiyon tipi intramedüller çivileme ile reimplantasyon uygulandı. Ameliyat sonrası klinik (komplikasyonlar), radyolojik (kaynama süresi) ve fonksiyonel sonuçların detaylı bir değerlendirmesi yapıldı. Fonksiyonel sonuçlar, Musculoskeletal Tumor Society Score (MSTS) kullanılarak değerlendirildi. Sonuçlar: Çalışmaya ortalama yaşı 18,6 yıl (aralığı: 14-35 yıl) olan dokuz hasta dahil edildi; hastaların dördü erkek, beşi kadındı. Ortalama takip süresi 6,55 yıldı (aralığı: 4-19 yıl). Ortalama tümör boyutu 14,4 cm (aralığı: 11-20 cm) idi. Altı hastada (%66,6) zamanında kaynama gerçekleşirken, iki hastada kaynama gecikti ve birinde kaynamama görüldü; bu hastaların tümü yeniden müdahale ile veya müdahale olmaksızın iyileşti. Lokal veya sistemik enfeksiyon, greft kırığı veya implant yetmezliği gözlenmedi. Son takipte beş hastanın kür olduğuna karar verildi, üçünde hastalık mevcut fakat hayattaydı ve biri hastalıktan öldü. Ortalama MSTS skoru 89,5 idi (aralığı: 84-96). Sonuç: Sıvı nitrojenle işlenmiş otogreftler, özellikle yeterli yumuşak doku örtüsüne sahip genç hastalarda femoral diafiz sarkomları için güvenli, uygun maliyetli ve biyolojik olarak uygun bir rekonstrüksiyon seçeneği sunmaktadır. Standart bir teknik ve dikkatli bir augmentasyonla uygulandığında, bu yöntem olumlu kaynama oranları ve uzun vadeli fonksiyonel sonuçlar sağlamaktadır.

Keywords

• biyolojik rekonstrüksiyon
• kemik kaynaması
• osteosarkom
• uzuv kurtarma
• Sıvı nitrojen

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