Biological Bone Reconstruction 骨肉瘤之生物性骨重建術

What is Biological Bone Reconstruction?

Biological bone reconstruction refers to the use of real bone to repair bone defects following surgery. These bones can come from:

Using either allografts or recycled autografts for biological reconstruction offers clear advantages in terms of bone integration, quality restoration, size and shape matching, and long-term durability.

Methods for Processing Recycled Bone

After completing adjuvant chemotherapy, the patient will undergo wide tumor resection. When an osteosarcoma or malignant bone tumor is extensively removed, a large bone defect is left behind. Orthopedic oncologists then use real bone (allograft or recycled autograft) to reconstruct the area.

The two most common methods for processing recycled autografts are:

1. Extracorporeal Irradiated Autograft (ECIR)

The removed bone segment is wrapped in sterile gauze and sealed in a double plastic bag. It is placed in a linear accelerator and irradiated with a single dose of 150–300 Gy to ensure all tumor tissue is destroyed. The treated bone is immediately re-implanted into the body and fixed with internal fixation devices.

2. Liquid Nitrogen Cryotherapy

The resected bone is frozen in liquid nitrogen at -196°C for 20 minutes. It is then thawed at room temperature for 15 minutes and further thawed in distilled water for 10 minutes. The treated bone is re-implanted and stabilized with internal fixation.

Clinical Outcomes and Advantages

Outcome Clinical Results：

• Bone union rate within 9 months >90%
• 5-year limb salvage rate 93%
• Bone graft survival rate 88%
• Average functional recovery score 88/100
• Tumor recurrence in the grafted bone 0 cases
• 5-year overall survival rate 83%

This technique offers significantly better outcomes than tumor prostheses (which have a survival rate of 60–70%) and more closely resembles natural bone structure.

Potential Risks and Management

1. Infection: May require antibiotics or additional debridement surgery.

2. Graft fracture: May require revision surgery.

Most complications occur within the first three years post-operation and are generally manageable with surgical intervention.

Frequently Asked Questions (FAQ)

Q: Is the surgery painful? How long is the recovery period?
A: Pain is controlled with medication post-surgery. Recovery typically takes 3–6 months, depending on individual patient conditions.

Q: Is there a risk of recurrence?
A: According to Taipei Veterans General Hospital's clinical records, there have been no cases of tumor recurrence within the recycled bone.

Q: When can I walk again?
A: Partial weight-bearing is usually possible within 1–3 months after surgery, based on bone healing progress and your physician's evaluation.

什麼是生物性骨重建

生物性骨重建是指使用真實骨頭來修補手術後的缺損，這些骨頭可能是：

異體骨（Allograft）： 來自捐贈者之骨頭

回收自體骨（Autograft）： 將患者原本帶有腫瘤的骨頭，經特殊處理後再植回體內

使用異體骨或回收自體骨進行生物性重建手術，在骨整合效果、骨質恢復、尺寸與形狀的適配性，以及使用年限等方面都有明顯優勢。

回收骨處理方式

在完成輔助化療後，病患將接受腫瘤廣泛切除，當骨肉瘤或惡性骨腫瘤被廣泛切除後，會留下巨大的骨缺損，這時骨腫瘤外科醫師會使用真實骨材（異體骨或回收自體骨）來進行重建。

常見的兩種回收自體骨處理方法為：

1. 體外高劑量放射處理（ECIR）

將切除的骨段用無菌敷料包裹並密封於雙層塑膠袋中。放入直線加速器中，以150–300Gy的放射線一次性照射，確保完全涵蓋腫瘤部位。照射後立即將該骨段重新植入體內，並使用內固定材料進行固定。

2. 冷凍液態氮處理

將切下的骨段放入-196C液態氮中冷凍20分鐘。然後在室溫下解凍15分鐘，再在蒸餾水中持續解凍10分鐘。最後將處理後的骨段重新植入並用內固定材料固定。

潛在風險與處理方式

1. 感染：可能需要使用抗生素或再次清創手術

2. 骨移植段斷裂：需進行再次手術修復

常見問題（FAQ）

Q：這項手術會痛嗎？恢復期多長？
A：手術後會使用止痛藥控制疼痛，恢復期約 3–6 個月，根據每位患者狀況調整。

Q：會不會復發？
A：目前台北榮總的臨床紀錄中，尚未出現「回收骨內」腫瘤復發的案例。

Q：什麼時候可以重新走路？
A：通常術後 1–3 個月可部分負重，視骨癒合進度與醫師評估而定。

台北榮總成效臨床統計

超過90%的骨移植物可在9個月內達成穩固的生物性癒合，恢復真正的骨質。

五年肢體保存率達93%，而骨移植存活率為88%，比腫瘤義肢（60–70%）高出許多。

患者的平均肢體功能得分為88%。

沒有發現任何回收骨移植物導致的腫瘤復發。

五年整體病患存活率為83%，顯示此為一種安全且理想的肢體重建方法。