对于骨肉瘤患者的护理，某些外科医生更倾向于通过植入切除的带瘤肿瘤段来进行生物重建。冷冻自体移植优势在于具有经济性，完美贴合，保持了成骨诱导和成骨导引特性，并且不会传播病毒病。有关带支柱的冷冻自体移植技术，仅制作一个骨切口用于冷冻程序，使带瘤段与宿主骨和软组织相连，而不是两个骨切口，也使带瘤段与宿主骨和软组织保持连接，这样比两个骨切口的自由冷冻移植更能快速恢复血流。(1) 使用这种冷冻自体移植技术，在6个月内有多少比例的患者实现了愈合？(2) 在使用这种方法的一个小系列中，观察到了哪些并发症？(3) 根据肌骨肿瘤学会（MSTS）评分，这些患者的功能如何？(4) 有多少比例的患者出现局部复发？在2014年至2017年期间，我们治疗了87例股骨、胫骨或肱骨原发肉瘤患者。其中，我们认为那些能够接受间插性切除并对新辅助化疗具有良好反应的患者可能适合使用这种技术。根据这些标准，有49%（43例）的患者符合条件；另有9%（8例）因骨质质量不足（CT评估下皮质厚度小于50%）而被排除。我们回顾性研究了32例接受单一干骺端骨切口的冰冻支柱技术治疗的患者。其中有20名男性和12名女性。中位年龄为18岁（范围13岁至48岁）。中位随访时间为55个月（范围48至63个月）。通过临床和放射学评估患者的联合情况（在本研究中定义为6个月内四个皮层中有三个皮层的骨桥），局部复发比例，非肿瘤并发症发生情况和MSTS评分。32名患者中，3%（1例）患者发生非联合（9个月内没有愈合）。中位MSTS评分为90%，最后一次随访时无转移的证据。9%（3例）患者死亡。局部复发率为3.1%（32名患者中的1例）。60个月（5年）的平均限制性无病生存时间为58个月（95% CI 55至62个月）。32名患者中，25%（8例）出现非肿瘤并发症。包括表浅皮肤烧伤（2例）、表浅伤口感染（2例）、深静脉血栓形成（1例）、暂时性神经麻痹（2例）和永久性神经麻痹（1例）。对于能够进行间插性切除的股骨、胫骨和肱骨肉瘤患者，这种治疗方法相对成功，并且不涉及骺盘和上端干骺端。它避免了以前报告的冻结技术中的第二个骨切口，并且除一例外所有患者均实现了愈合。并发症和局部复发较少，患者的功能良好。这种技术不能在所有长骨肉瘤中使用，但我们认为在对新辅助化疗有良好反应的患者、可以进行间插性切除并至少保留2 cm骨基底区域且具有足够骨质的患者中，这是一个合理的替代治疗。在专门中心进行这种技术的经验丰富的外科医生是执行该技术的关键。需要进一步研究以比较这种技术与其他重建选项的效果。第四级治疗研究。版权所有©2023年骨科和关节外科医师协会。

Biological reconstruction by replanting the resected tumor-bearing segment is preferred by some surgeons when caring for a patient with a bone sarcoma. Frozen autografts are advantageous because they are cost-effective, provide an excellent fit, permit the maintenance of osteoinductive and osteoconductive properties, and are not associated with transmission of viral disease. The pedicle frozen autograft technique, in which only one osteotomy is made for the freezing procedure, keeping the affected segment in continuity with the host bone and soft tissue instead of two osteotomies, maintains the affected segment with the host bone and soft tissue. This could restore blood flow more rapidly in a frozen autograft than in a free-frozen autograft with two osteotomies.(1) In what proportion of patients was union achieved by 6 months using this technique of frozen autografting? (2) What complications were observed in a small series using this approach? (3) What was the function of these patients as determined by Musculoskeletal Tumor Society (MSTS) score? (4) What proportion of patients experienced local recurrence?Between 2014 and 2017, we treated 87 patients for primary sarcomas of the femur, tibia, or humerus. Of those, we considered patients who could undergo intercalary resection and showed a good response to neoadjuvant chemotherapy as potentially eligible for this technique. Based on these criteria, 49% (43 patients) were eligible; a further 9% (eight) were excluded because of inadequate bone quality (defined as cortical thickness less than 50% by CT assessment). We retrospectively studied 32 patients who were treated with a single metaphyseal osteotomy, the so-called pedicle freezing technique, which uses liquid nitrogen. There were 20 men and 12 women. The median age was 18 years (range 13 to 48 years). The median follow-up duration was 55 months (range 48 to 63 months). Patients were assessed clinically and radiologically regarding union (defined in this study as bony bridging of three of four cortices by 6 months), the proportion of patients experiencing local recurrence, the occurrence of nononcologic complications, and MSTS scores.Three percent (one of 32) of the patients had nonunion (no union by 9 months). The median MSTS score was 90%, with no evidence of metastases at the final follow-up interval. Nine percent (three of 32) of our patients died. The local recurrence rate was 3.1% (one of 32 patients). The mean restricted disease-free survival time at 60 months (5 years) was 58 months (95% CI 55 to 62 months). Twenty-five percent of patients (eight of 32) experienced nononcologic complications. This included superficial skin burns (two patients), superficial wound infection (two patients), deep venous thrombosis (one patient), transient nerve palsy (two patients), and permanent nerve palsy (one patient).This treatment was reasonably successful in patients with sarcomas of the femur, tibia, and humerus who could undergo an intercalary resection, and this treatment did not involve the epiphysis and upper metaphysis. It avoids a second osteotomy site as in prior reports of freezing techniques, and union was achieved in all but one patient. There were few complications or local recurrences, and the patients' function was shown to be good. This technique cannot be used in all long-bone sarcomas, but we believe this is a reasonable alternative treatment for patients who show a good response to neoadjuvant chemotherapy, those in whom intercalary resection is feasible while retaining at least 2 cm of the subchondral area, and in those who have adequate bone stock to withstand the freezing process. Experienced surgeons who are well trained on the recycling technique in specialized centers are crucial to perform the technique. Further study is necessary to see how this technique compares with other reconstruction options.Level IV, therapeutic study.Copyright © 2023 by the Association of Bone and Joint Surgeons.