[Allograft of clavicle for reconstruction of bone defect after tumor resection].
OBJECTIVE
To evaluate the effects of allogeneic bone graft for reconstructing bone defect of clavicle after tumor resection.


METHODS
Nine patients received the surgical procedures for repairing and reconstructing bone defect after resection of clavicle tumor from January 2000 to January 2006. There were 4 males and 5 females aged 12 to 68 years. Two patients were diagnosed as having benign tumor and tumor-like lesion (stage III according to Campanacci grading), and 7 as having primary malignant tumor and metastatic cancer. Three lesions were located in acromial end, 2 in sternal end and 4 in shaft of clavicle. Two cases was accompanied by pathological fracture. According to Enneking's functional evalutation, the results were excellent in 3 cases, good in 3 cases, fair in 1 case and poor in 2 cases. Based on the visual analogue scale (VAS), pain was rated as medium rest-pain in 4 cases, as medium move-pain in 3 cases and heavy pain in 2 cases preoperatively. The tumor was resected with en bloc. Defected clavicles were reconstructed by a part of allograft clavicle and plate. The patients with malignant tumor received neo-adjuvant chemotherapy and radiotherapy postoperatively. The results were evaluated according to control of tumor, relief of pain, bone healing and shoulder joint function.


RESULTS
These patients were followed up 12 to 70 months (mean 34.6 months). There were no local recurrence and metastases in all patients during the follow-up. No complications of immune rejection and deep infection were seen. The normal shape of the shoulders was restored. Eight of all patients showed primary bone healing between allograft bone and host bone. The mean healing time was 5.4 months (3.2-6.8 months). Loosening of the plate and nonunion were seen in 1 case; and bone grafting was given again. Fracture of allograft occurred in 1 case after removing internal fixation. According to Enneking's functional evulation, the results were excellent in 6 cases and good in 3 cases at 3 months after operation; excellent in 4 cases, good in 1 case and fair in 1 case among 6 patients who were followed up for 24 months. The VAS results of postoperation showed light move-pain in 2 cases at 3 months, light move-pain and medium move-pain in 1 case respectively and no pain in 7 cases 12 months after operation.


CONCLUSIONS
Allogeneic clavicle is a useful and reliable reconstructive material for clavicle defect due to tumor resection. The satisfactory shape and favorable function of the shoulder may be recovered after this procedure.
Guo
Zheng
Z
Institute of Orthopaedics, Xijing Hospital, Fourth Military Medical University, Xi'an Shaanxi, 710032, P. R. China. guozheng@fmmu.edu.cn
Wang
Zhen
Z
Wang
Zhe
Z
Zhang
Yongquan
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016025:Bone Transplantation / Q000379:methods*; D017024:Chemotherapy, Adjuvant; D002648:Child; D002968:Clavicle / Q000473:pathology / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012516:Osteosarcoma / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D018714:Radiotherapy, Adjuvant; D016059:Range of Motion, Articular; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000503:physiopathology; D013524:Surgical Flaps; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult