Allograft-prosthesis composite for surgical treatment in patients with malignant tumors of the long bones (review)
DOI:
https://doi.org/10.15674/0030-598720152120-125Keywords:
allograft-prosthesis composite, bone allografts, bone tumorsAbstract
This review is dedicated to substitution of bone defects in case of surgical treatment of patients with malignant bone tumors of the extremities. The most frequent locations of tumors are the areas in proximal humerus, femur and tibia. In present time in treatment of the patients with such lesions a promising method is allograft-prosthesis composite (APC) which was firstly used in the mid-1980s. In the article we present the results of research on benefits and drawbacks of existing methods of substitution of large bone defects comparing to APC. Particularly, in cases of arthroplasties refixation of muscles and tendons to the implant is a challenge problem, and a nascence of immune reactions, lysis and fracture of a graft are disadvantages of alloplasty of bone defects. APC method combines the advantages of arthroplasty and alloplasty. The authors presented the features of this technique proper selection and strict observance of which is indisputable condition of successful treatment outcomes. The main problem to be solved during surgery is stable allograft fixation to the endoprosthesis and allocomposite endoprosthesis to the bone of recipient. They might be solved through the use of cement fixation of allocomposite endoprosthesis and different types of osteotomy. Particular attention is paid to the restoration of soft tissue around the joints during surgery. The main objective of this phase of surgery is to ensure the stability of the joint in operated limb segment and biological refixation of muscles which creates prerequisites for restoration of function of the limb. The paper describes some types of allografts that can be used for APC and methods of their manufacturing (with help of low temperatures or γ-radiation). We presented indications and contraindications to APC. The main complications after APC experts called infectious ones as well as resorption, fractures and nonunion of allografts with bone.References
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