Background/Objectives: Liquid nitrogen-treated frozen autograft is a biological reconstruction method developed at Kanazawa University for malignant bone tumors. However, nonunion between the treated autograft and host bone remains a complication. In this study, we aimed to identify factors influencing bone union in patients undergoing this procedure for osteosarcoma of long bones in the lower extremities.Methods: We retrospectively analyzed 35 osteosarcoma patients (mean age: 18.0 years) with lower limb long bone tumors treated with frozen autograft between 1999 and 2023. Factors assessed included sex, age, tumor location, fixation method (plate or intramedullary nail), technique (pedicle or free freezing), chemotherapy, and bone union.Results: Nonunion occurred in 6 cases: 2/25 with plate fixation (8.0%) and 4/10 with intramedullary nails (40%). The mean union time was shorter with plates (5.8 months) than with nails (7.2 months). Intramedullary nail use was significantly associated with nonunion (p< 0.05). Among plate fixations, nonunion occurred in 5.6% of multiple plates versus 14.3% of a single plate.Conclusions: Intramedullary nail fixation is associated with nonunion in biological reconstructions of long bones, consistent with previous reports. Multiple-plate fixation after frozen autograft with liquid nitrogen for osteosarcoma of the lower limb long bone should be considered.
背景/目的：液氮处理冷冻自体骨移植是金泽大学针对恶性骨肿瘤开发的一种生物重建方法。然而，移植骨与宿主骨之间的骨不连仍是该手术的并发症。本研究旨在探讨影响下肢长骨骨肉瘤患者接受此手术后骨愈合的相关因素。 方法：我们回顾性分析了1999年至2023年间接受冷冻自体骨移植治疗的35例下肢长骨骨肉瘤患者（平均年龄18.0岁）。评估因素包括性别、年龄、肿瘤位置、固定方式（钢板或髓内钉）、技术方法（带蒂或游离冷冻）、化疗情况以及骨愈合状态。 结果：共发生6例骨不连：钢板固定组25例中有2例（8.0%），髓内钉固定组10例中有4例（40%）。钢板固定组的平均愈合时间（5.8个月）短于髓内钉组（7.2个月）。髓内钉的使用与骨不连显著相关（p<0.05）。在钢板固定组中，多钢板固定的骨不连发生率为5.6%，而单钢板固定为14.3%。 结论：髓内钉固定与长骨生物重建中的骨不连相关，这与既往研究结果一致。对于下肢长骨骨肉瘤的液氮冷冻自体骨移植术，应考虑采用多钢板固定方式。
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