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상전골근위단에 發生한 巨大細胞腫 除去後 行한 비골이식의 二例

2 cases of replacement of the bone defect by a fibular graft after the resection of a giant cell tumor arising from the proximal end of the humerus

최신의학 1959년 2권 12호 p.121 ~ 126
민영옥,
소속 상세정보
민영옥 ( Min Yung-Ock ) - 부산대학교 의과대학 외과학교실

Abstract


Since Albee´s publication of bone graft in 1915, various types of bone graft have been indicated in the operation of delayed union and pseudoarthrosis. However, it was rather rare to see a report of a resection of a bone tumor followed by a -bone graft replacing the defect by a piece of another long bone. The author presented 2 cases of bone graft treated after the resection of a giant cell tumor arising from the proximal end of the right humerus. Both patients were 31 years old and house wives. The location of the tumors was also the same: the proximal end of right humerus; one case showed lateral expansion, and another one medial expansion, causing a pressure on vessels and nerves. The tumors were also the same in pathological character, that is, giant cell tumors with very compact cellular stroma showing de-finite evidence of atypism, grade II according to Jaffe´s classification. Roentgenogram of both cases showed the same osteolytic giant cell tumor with no evidence of metastases of lung and skull. The method of operation was the same in both cases.
After a skin incision in the deltopectoral groove, the proximal portion of the humerus was re-moved (9 cm for the 1st case,
14.5 cm for the 2nd case), together with the tumor mass. The defect of the humerus was replaced by a piece of proximal portion taken out of the fibula of same side. However, in the 1st case the fibular graft was inserted into the medullary canal of the remaining portion of the humerus, after inserting the Kiintscher´s nail in its medullary canal. In the 2nd case, only the fibular graft was tightly fitted into the remaining medullary canal without inserting the nail. The course after operation of both cases was satisfactory and the patients were discharged with the fixed cast in about 80 degree abduction. It is difficult to judge the possible recovery of the shoulder function without a follow-up study over a long period. However, according to the previous literature the author hope-fully expects satisfactory recovery of function. According to these experiences the author believes that the above mentiond method of bone graft would be worth trying even in cases showing histological malignant evidence in the cell stroma without severe infiltration in surrounding tissues. It is also applicable in several similar defective conditions, such as chronic diffuse osteomyelitis or compound fracture.

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