Clinical Comparison Of Different Composite Biological Reconstructive Technique For The Reconstruction Of Massive Bone Defect

Backgrounds:Capanna technique was firstly reported in 1993,in which allograft combined with vascular fibula compound biological reconstruction technique for massive bone defect after bone tumor resection.Over 30 years of clinical application results showed that the Cappana technique integrates the advantage of the allograft reconstruction and vascularized fibula graft,so that achieving good limb function and reducing complications.Inspired by the Capanna technique,in the past 10 years,we applied large segment inactivated tumor bone composite with vascularized fibula to reconstruct massive bone defects.The clinical application results showed that this method can obtain satisfactory clinical efficacy.However,there is still a lack of comparative study between different composite biological reconstruction techniques.Objectives:A llinical retrospective study was conducted to compare the differences between the two reconstruction techniques of tumor-bearing frozen autograft/VFG and Capanna technique in tumor control,limb function recovery,bone healing and complications.Methods:Twenty-three patients who presented with Enneking stage ⅡB osteosarcoma of a lower extremity(mean age: 14.1 years,range: 8-22 years)between June 2011 and Jan2016 were enrolled in this study.Frozen autograft/VFG reconstruction(group A)and allograft/VFG reconstruction(group B)was performed after tumor resection in 8 and 15 patients,respectively.Oncologic outcomes(local recurrence and metastasis)were assessed clinically and radiologically.The survival of patients was estimated using the Kaplan-Meier method.Functional status of the limb was evaluated using the Musculoskeletal Tumor Society(MSTS)-93 scoring system.Duration of surgery,intraoperative blood loss,time to union and complications were also recorded and compared.Results:There was no difference in the demographics(age,sex,and affected site)and operative procedures(resection length,duration of surgery,and blood loss)between the two groups(p>0.05).One patient(12.5%)in group A and another in group B(6.67%)developed local tumor recurrence 9 months and 42 months after surgery,respectively.At the final follow-up,two patients(25.0%)in group A and 5 in group B(33.3%)had died of lung metastasis.The survival rate in group A was slightly higher than in group B,although there was no significant difference using Kaplan-Meier analysis.Mean MSTS scores in groups A and B were 90.3% and 88.0 %,respectively,a difference that was not significantly(p=0.535).Frozen autograft-host junctions had united after a mean of 8.4months,which was significantly earlier than in allograft-host junctions(11.9 months,p<0.001).In terms of complications,infection occurred in one patient(6.7%)and delayed union occurred in two patients(13.3%)in group B,but,no such complications were observed in group A.Conclusions:The use of frozen tumor-bearing autografts combined with VFG represents an alternative to allograft/VFG reconstruction in properly selected patients with non-osteolytic osteosarcoma.It is a procedure which did not increase the risk of tumor recurrence or metastasis and had the advantage of earlier bony union in addition to a lower rate of complications.