RECONSTRUCTION OF BONE DEFECTS AFTER TUMOR RESECTION BY AUTOAND ALLOGRAFTS (review of literature)

Cover Page


Cite item

Full Text

Abstract

The problem of replacement of large bone defects resulting from segmental bone resections in patients with bone tumors is still actual in modern orthopedics. Segmental defects cause the main difficulty especially in cases of disturbance of normal biomechanics while the “gold standard” of reconstruction with bone autograft is not always possible. The reason is that the defect can be so extensive that would make it impossible to harvest necessary autobone stock. Therefore, allografts based on demineralized bone with optimal properties for osteoregeneration are used as an alternative for autograft. For certain composite materials it is possible to program the properties of future graft by changing its compound. Literature analysis revealed that the effectiveness of the allograft in combination with additional components is comparable to autograft effectiveness. Mesenchymal stem cells of both bone marrow and adipose tissue can be used as an additional component to improve osteoregeneration. It is noteworthy that the analyzed studies did not reveal the influence of stem cells on the tumor recurrence. Nevertheless, the authors support the need of further researches in this area to confirm gained results. Some authors still prefer traditional methods of bone traction despite obtaining own satisfactory results of defects reconstruction with allografts. Such opinion is based on proven effectiveness of the method, structural stability of construction during treatment period and ability to adjust the process of bone regeneration at any stage. The authors goal was to analyze publications over the recent 5 years with the results of experiments and clinical studies on the replacement of large bone defects after bone tumor resection with autoand allografts. Based on the literature analysis the authors propose a general algorithm for graft selection in replacement of large bone defects after segmental bone resections. 

About the authors

E. A. Anastasieva

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Evgenia A. Anastasieva — Clinical Resident 

17, ul. Frunze, Novosibirsk, 6630091

Russian Federation

M. A. Sadovoy

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Mikhail A. Sadovoy — Dr. Sci. (Med.), Professor, Director 

17, ul. Frunze, Novosibirsk, 6630091

Russian Federation

V. V. Voropaeva

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Email: fake@neicon.ru

Anastasia A. Voropaeva — Cand. Sci. (Med.), Researcher, Laboratory and Experimental Department 

17, ul. Frunze, Novosibirsk, 6630091

Russian Federation

I. A. Kirilova

Tsivyan Novosibirsk Research Institute of Traumatology and Orthopedics

Author for correspondence.
Email: IKirilova@niito.ru

Irina A. Kirilova — Dr. Sci. (Med.), Head of the Research Department 

17, ul. Frunze, Novosibirsk, 6630091

Russian Federation

References

  1. Qu H., Guo W., Yang R., Li D., Tang S., Yang Y., Dong S., Zang J. Reconstruction of segmental bone defect of long bones after tumor resection by devitalized tumor-bearing bone. World J Surg Oncol. 2015;13:282. doi: 10.1186/s12957-015-0694-3.
  2. Guerado E., Caso E. Challenges of bone tissue engineering in orthopaedic patients. World J Orthop. 2017;8(2):87-98. doi: 10.5312/wjo.v8.i2.87.
  3. Glatt V., Evans C.H., Tetsworth K. A Concert between biology and biomechanics: the influence of the mechanical environment on bone healing. Front Physiol. 2016;7:678. doi: 10.3389/fphys.2016.00678.
  4. Elefteriou F., Campbell P., Ma Y. Control of Bone Remodeling by the Peripheral Sympathetic Nervous System. Calcif Tissue Int. 2014;94(1):140-151. doi: 10.1007/s00223-013-9752-4.
  5. Muramatsu K., Ihara K., Miyoshi T., Yoshida K., Iwanaga R., Hashimoto T., Taguchi T. Stimulation of neo-angiogenesis by combined use of irradiated and vascularized living bone graft for oncological reconstruction. Surg Oncol. 2012;21(3):223-229. doi: 10.1016/j.suronc.2011.12.004.
  6. Казарезов М.В., Прохоренко В.М., Королева А.М. Ортопедия и восстановительная хирургия. Новосибирск: ННИИТО, НПО «БРИЗ»; 2008. 448 c. Kazarezov M.V., Prokhorenko V.M., Koroleva A.M. [Orthopedics and reconstructive surgery]. Novosibirsk: NNIITO, NGO “BREEZE”; 2008. 448 р. (in Russian).
  7. Балберкин А.В., Шавырин Д.А. Клиника, диагностика и хирургическое лечение опухолей костей области коленного сустава (обзор литературы). Саркомы костей, мягких тканей и опухоли кожи. 2013;(1):15-23. Balberkin A.V., Shavyrin D.A. [Clinic, diagnostics and surgical treatment of bone tumors of the knee joint region (literature review)]. Sarkomy kostei, myagkikh tkanei i opukholi kozhi [Sarcomas of bone, soft tissue and skin tumors]. 2013;1:15-23. (in Russian).
  8. Терсков А.Ю., Иванов В.В., Николаенко А.Н. Наша тактика в диагностике и лечении больных с гигантоклеточными опухолями костей. Гений ортопедии. 2013; (2):67-71. Terskov A.Ju., Ivanov V.V., Nikolaenko A.N. [Our tactics in diagnostics and treatment of patients with giant cell tumor of bone]. Genij Ortopedii [Orthopedic Genius]. 2013;(2): 67-71. (in Russian).
  9. Dittrich C., Kosty M., Jezdic S. et al. ESMO / ASCO Recommendations for a Global Curriculum in Medical Oncology. Edition 2016. ESMO Open. 2016;1(5):e000097. doi: 10.1136/esmoopen-2016-000097.
  10. Fritzsche H., Schaser K.D., Hofbauer C. [Benign tumours and tumour-like lesions of the bone: general treatment principles]. Orthopade. 2017; 46(6):484-497. (in German). doi: 10.1007/s00132-017-3429-z.
  11. Hillmann A., Gösling T. [Benign bone tumors. General principles]. Unfallchirurg. 2014;117(10):873-882. (in German). doi: 10.1007/s00113-014-2577-4.
  12. Leavey P.J. Important principles in Ewing sarcoma treatment. Pediatr Blood Cancer. 2014;61(12):2149-2150. doi: 10.1002/pbc.25214.
  13. Mavrogenis A.F., Angelini A., Vottis C., Palmerini E., Rimondi E., Rossi G., Papagelopoulos P.J., Ruggieri P. State-of-the-art approach for bone sarcomas. Eur J Orthop Surg Traumatol. 2015;25(1):5-15. doi: 10.1007/s00590-014-1468-2.
  14. Panagopoulos G.N., Mavrogenis A.F., Mauffrey C., Lesenský J., Angelini A., Megaloikonomos P.D., Igoumenou V.G., Papanastassiou J., Savvidou O., Ruggieri P., Papagelopoulos P.J. Intercalary reconstructions after bone tumor resections: a review of treatments. Eur J Orthop Surg Traumatol. 2017;27(6):737-746. doi: 10.1007/s00590-017-1985-x.
  15. Borzunov D.Y., Balaev P.I., Subramanyam K.N. Reconstruction by bone transport after resection of benign tumors of tibia: A retrospective study of 38 patients. Indian J Orthop. 2015;49(5):516-522. doi: 10.4103/0019-5413.164042.
  16. Puri A., Gulia A., Byregowda S., Ramanujan V. Reconstruction of the elbow and forearm for Ewing sarcoma of ulna: A new biological technique. Int J Shoulder Surg. 2016;10(2):85-88. doi: 10.4103/0973-6042.180721.
  17. Puri A. Limb salvage in musculoskeletal oncology: Recent advances. Indian J Plast Surg. 2014;47(2):175-184. doi: 10.4103/0970-0358.138937.
  18. Puri A., Gulia A. Management of extremity soft tissue sarcomas. Indian J Orthop. 2011;45:301-306.
  19. Тихилов Р.М., Пташников Д.А., Микайлов И.М., Засульский Ф.Ю., Григорьев П.В. Оперативное лечение больных c гигантоклеточной опухолью костей. Онкология. Журнал им. П.А. Герцена. 2017;6(1):5-11. Tikhilov R.M., Ptashnikov D.A., Mikailov I.M., Zasulsky F.Yu., Grigoryev P.V. [Surgical treatment for giant cell tumor of the bones]. Onkologiya. Zhurnal imeni P.A. Gertsena [Herzen Journal of Oncology]. 2017;6(1):5-11. (in Russian).
  20. Ramphal R., Aubin S., Czaykowski P., De Pauw S., Johnson A., McKillop S., Szwajcer D., Wilkins K., Rogers P. Adolescent and young adult cancer: principles of care. Curr Oncol. 2016;23(3):204-209. doi: 10.3747/co.23.3013.
  21. Садовой М.А., Мацук С.А., Сагдеев Д.О., Подорожная В.Т., Кирилова И.А., Мацук К.С. Хирургическое лечение костных опухолей у детей. Травматология және ортопедия. 2007;(2):134-137. Sadovoj M.A., Macuk S.A., Sagdeev D.O., Podorozh naya V.T., Kirilova I.A., Macuk K.S. [Surgical treatment of bone tumors in children]. Travmatologiya zhene ortopediya [Rheumatology and Orthopedics]. 2007;(2): 134-137. (in Russian).
  22. Нисиченко Д.В., Хестанов Д.Б., Михайлова Е.В., Харбедия В.Х., Илюшина О.В., Малахова А.А., Дзампаев А.З., Алиев М.Д. Субтотальная резекция большеберцовой кости в НИИ детской онкологии и гематологии ФГБУ «РОНЦ им. Н.Н. Блохина» Минздрава России. Саркомы костей, мягких тканей и опухоли кожи. 2017;(1):52-58. Nisichenko D.V., Hestanov D.B., Mihajlova E.V., Harbedija V.H., Iljushina O.V., Malahova A.A., Dzampaev A.Z., Aliev M.D. [Subtotal resection of the tibia at the Research Institute of Pediatric Oncology and Hematology FGBI “RCRC. n.a. N.N. Blokhin” of the Ministry of Health of Russia]. Sarkomy kostei, myagkikh tkanei i opukholi kozhi [Sarcomas of bone, soft tissue and skin tumors]. 2017;(1): 52-58. (in Russian).
  23. Nieminen J., Pakarinen T.K., Laitinen M. Orthopaedic reconstruction of complex pelvic bone defects. Evaluation of various treatment methods. Scand J Surg. 2013;102(1):36-41. doi: 10.1177/145749691310200108.
  24. Ryzhikov D.V., Gubina E.V., Podorozhnaya V.T., Senchenko E.V., Sadovoy M.A. Repair of defects and osteosynthesis of long bones in children with osteoclastoma. AIP Conference Proceedings. 2016; 1760(1). 020059. doi: 10.1063/1.4960278.
  25. Иванова М.В., Карпенко В.Ю., Бухаров А.В., Державин В.А. Эндопротезирование плечевого сустава при метастатическом поражении проксимального отдела плечевой кости на фоне иммуносупрессивной терапии. Исследования и практика в медицине. 2017; 4(1):58-62. Ivanova M.V., Karpenko V.Ju., Buharov A.V., Derzhavin V.A. [Endoprosthetics of the shoulder joint with a metastatic lesion of the proximal humerus on the background of immunosuppressive therapy]. Issledovaniya i praktika v meditsine. [Research and practice in medicine]. 2017;4(1):58-62.
  26. Khan Z., Hussain S., Carter S.R. Tumours of the foot and ankle. Foot (Edinb). 2015;25(3):164-172. doi: 10.1016/j.foot.2015.06.001.
  27. Gupta S.K., Alassaf N., Harrop A.R., Kiefer G.N. Principles of rotationplasty. J Am Acad Orthop Surg. 2012; 20(10):657-667. doi: 10.5435/JAAOS-20-10-657.
  28. Malviya A., Gerrand C. Evidence for orthopaedic surgery in the treatment of metastatic bone disease of the extremities: a review article. Palliat Med. 2012;26(6): 788-796. doi: 10.1177/0269216311419882.
  29. Piccioli A., Maccauro G., Spinelli M.S., Biagini R., Rossi B. Bone metastases of unknown origin: epidemiology and principles of management. J Orthop Traumatol. 2015;16(2):81-86. doi: 10.1007/s10195-015-0344-0.
  30. Cheng D., Yang J., Hu T., Yang Q. Efficacy of limb salvage with primary tumor resection simultaneously for solitary bone metastasis in limbs. World J Surg Oncol. 2015;14(1):31. doi: 10.1186/s12957-016-0786-8.
  31. Gösling T., Becker-Schiebe M. [Surgical treatment of skeletal metastases]. Unfallchirurg. 2015;118(4):347-363. (in German). doi: 10.1007/s00113-015-2742-4.
  32. Scolaro J.A., Lackman R.D. Surgical management of metastatic long bone fractures: principles and techniques. J Am Acad Orthop Surg. 2014;22(2):90-100. doi: 10.5435/JAAOS-22-02-90.
  33. Wessling M., Pflugmacher R., Müller M.C., Kabir K., Pennekamp P.H. [Basic principles of surgical treatment of bone metastases]. Z Orthop Unfall. 2013;151(3):303-314; quiz 315. (in German). doi: 10.1055/s-0032-1328634.
  34. Aponte-Tinao L.A., Ritacco L.E., Albergo J.I., Ayerza M.A., Muscolo D.L., Farfalli G.L. The principles and applications of fresh frozen allografts to bone and joint reconstruction. Orthop Clin North Am. 2014;45(2):257-269. doi: 10.1016/j.ocl.2013.12.008.
  35. Кирилова И.А., Садовой М.А., Подорожная В.Т. Сравнительная характеристика материалов для костной пластики: состав и свойства. Хирургия позвоночника. 2012;(3):72-83. Kirilova I.A., Sadovoy M.A., Podorozhnaja V.T. [Comparative Characteristics of Materials for Bone Grafting: Composition and Properties]. Khirurgiya pozvonochnika. [Spine Surgery]. 2012;(3):72-83. (in Russian).
  36. Подорожная В.Т., Садовой М.А., Кирилова И.А., Шаркеев Ю.П., Легостаева Е.В. Аллогенные костные материалы: структура, свойства, применение. Известия высших учебных заведений. Физика. 2013;56 (12-3):14-20. Podorozhnaya V.T., Sadovoj M.A., Kirilova I.A., Sharkeev Yu.P., Legostaeva E.V. [Allogeneic bone materials: structure, properties, application]. Izvestiya vysshikh uchebnykh zavedenii. Fizika [Proceedings of Higher Schools. Physics.]. 2013;56(12-3):14-20. (in Russian).
  37. Gharedaghi M., Peivandi M.T., Mazloomi M., Shoorin H.R., Hasani M., Seyf P., Khazaee F. Evaluation of Clinical Results and Complications of Structural Allograft Reconstruction after Bone Tumor Surgery. Arch Bone Joint Surg. 2016;4(3):236-242.
  38. Zamiri B., Shahidi S., Eslaminejad M.B., Khoshzaban A., Gholami M., Bahramnejad E., Moghadasali R., Mardpour S., Aghdami N. Reconstruction of human mandibular continuity defects with allogenic scaffold and autologous marrow mesenchymal stem cells. J Craniofac Surg. 2013;24(4):1292-1297. doi: 10.1097/SCS.0b013e318294288a.
  39. Ayerza M.A., Piuzzi N.S., Aponte-Tinao L.A., Farfalli G.L., Muscolo D.L. Structural allograft reconstruction of the foot and ankle after tumor resections. Musculoskelet Surg. 2016;100(2):149-156. doi: 10.1007/s12306-016-0413-4.
  40. Chen W.M., Wu P.K., Chen C.F., Chung L.H., Liu C.L., Chen T.H. High-grade osteosarcoma treated with hemicortical resection and biological reconstruction. J Surg Oncol. 2012;105(8):825-829. doi: 10.1002/jso.23005.
  41. Gouron R. Surgical technique and indications of the induced membrane procedure in children. Orthop Traumatol Surg Res. 2016;102(1 Suppl):S133-139. doi: 10.1016/j.otsr.2015.06.027.
  42. Halim A.S., Chai S.C., Wan Ismail W.F., Wan Azman W.S., Mat Saad A.Z., Wan Z. Long-term outcome of free fibula osteocutaneous flap and massive allograft in the reconstruction of long bone defect. J Plast Reconstr Aesthet Surg. 2015;68(12):1755-1762. doi: 10.1016/j.bjps.2015.08.013.
  43. Han G., Wang Y., Bi W., Jia J., Wang W., Xu M.. Zheng X., Mei L., Yang M.Reconstruction using massive allografts after resection of extremity osteosarcomas the study design: A retrospective cohort study. Int J Surg. 2015;21:108-111. doi: 10.1016/j.ijsu.2015.07.686.
  44. Houdek M.T., Wagner E.R., Stans A.A., Shin A.Y., Bishop A.T., Sim F.H., Bishop A.T., Sim F.H., Moran S.L. What Is the Outcome of Allograft and Intramedullary Free Fibula (Capanna Technique) in Pediatric and Adolescent Patients With Bone Tumors? Clin Orthop Relat Res. 2016;474(3): 660-668. doi: 10.1007/s11999-015-4204-2.
  45. Li J., Shi L., Chen G.J. Image navigation assisted jointsaving surgery for treatment of bone sarcoma around knee in skeletally immature patients. Surg Oncol. 2014;23(3):132-139. doi: 10.1016/j.suronc.2014.04.004.
  46. Farfalli G.L., Aponte-Tinao L., Lopez-Millan L., Ayerza M.A., Muscolo D.L. Clinical and functional outcomes of tibial intercalary allografts after tumor resection. Orthopedics. 2012;35(3):e391–396.
  47. Nogueira Drumond J.M. Benign bone tumors and tumorlike bone lesions: treatment update and new trends. Rev Bras Ortop. 2015;44(5):386-390. doi: 10.1016/S2255-4971(15)30267-6.
  48. Wang W., Wang Y., Bi W., Yang J., Han G, Ia J., Xu M., Liu G. Allogeneic bone transplantation for pelvic reconstruction of large skeletal defects after tumor resection. Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2014;28(3):331-334. (in Chinese).
  49. Gouron R., Deroussen F., Plancq M.C., Collet L.M. Bone defect reconstruction in children using the induced membrane technique: a series of 14 cases. Orthop Traumatol Surg Res. 2013;99(7):837-843. doi: 10.1016/j.otsr.2013.05.005.
  50. King J.J., Nystrom L.M., Reimer N.B., Gibbs C.P. Jr, Scarborough M.T., Wright T.W. Allograft-prosthetic composite reverse total shoulder arthroplasty for reconstruction of proximal humerus tumor resections. J Shoulder Elbow Surg. 2016;25(1):45-54. doi: 10.1016/j.jse.2015.06.021.
  51. Микайлов И.М., Григорьев П.В., Пташников Д.А., Майков С.В. Результаты эндопротезирования плечевого сустава у больных с новообразованиями проксимального отдела плечевой кости. Травматология и ортопедия России. 2014;(4):27-35. Mikailov I.M., Grigoriev P.V., Ptashnikov D.A., Maykov S.V. [Results of the proximal humerus endoprosthetic reconstruction after tumour resection]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2014;(4):27-35. (in Russian).
  52. Тихилов Р.М., Пташников Д.А., Засульский Ф.Ю., Микайлов И.М., Григорьев П.В., Плиев Д.Г. Ближайшие и среднесрочные результаты эндопротезирования тазобедренного сустава при опухолях проксимального отдела бедренной кости. Травматология и ортопедия России. 2014;(2):14-21. doi: 10.21823/2311-2905-2014-0-2-14-21. Tikhilov R.M., Ptashnikov D.A., Zasulskiy P.J., Mikailov I.M., Grigoriev P.V., Pliev D.G. [Shortand middle-term results of hip arthroplasty for tumors of the proximal femur]. Travmatologiya i ortopediya Rossii [Traumatology and Orthopedics of Russia]. 2014;(2):14-21. (in Russian). doi: 10.21823/2311-2905-2014-0-2-14-21.
  53. Müller D.A., Beltrami G., Scoccianti G., Cuomo P., Capanna R. Allograft-prosthetic composite versus megaprosthesis in the proximal tibia. What works best? Injury. 2016;47(Suppl 4):S124-S130. doi: 10.1016/j.injury.2016.07.043.
  54. Al Gheshyan F., Eltoukhy M., Zakaria K., Temple H.T., Asfour S. Comparison of gait parameters in distal femoral replacement using a metallic endoprosthesis versus allograft reconstruction. J Orthop. 2015;12(Suppl 1): S25-30. doi: 10.1016/j.jor.2015.01.022.
  55. Kotela A., Wilk-Frańczuk M., Żbikowski P., Łęgosz P., Ambroziak P., Kotela I. Revision knee arthroplasty in patients with inherited bleeding disorders: a single-center experience. Med Sci Monit. 2017;23:129-137.
  56. Rudert M., Holzapfel B.M., von Rottkay E., Holzapfel D.E., Noeth U. Impaction bone grafting for the reconstruction of large bone defects in revision knee arthroplasty. Oper Orthop Traumatol. 2015;27(1):35-46. doi: 10.1007/s00064-014-0330-3.
  57. Sakellariou V.I., Babis G.C. Management bone loss of the proximal femur in revision hip arthroplasty: Update on reconstructive options. World J Orthop. 2014;5(5): 614-622. doi: 10.5312/wjo.v5.i5.614.
  58. Nakamura K., Ohishi M., Matsunobu T., Nakashima Y., Sakamoto A., Maekawa A. Tumor-induced osteomalacia caused by a massive phosphaturic mesenchymal tumor of the acetabulum: A case report. Mod Rheumatol. 2016:1-5. [Epub ahead of print]. doi: 10.3109/14397595.2016.1173322
  59. Avril P., Le Nail L.-R., Brennan M.Á., Rosset P., De Pinieux G., Layrolle P., Heymann D., Perrot P., Trichet V. Mesenchymal stem cells increase proliferation but do not change quiescent state of osteosarcoma cells: Potential implications according to the tumor resection status. J Bone Oncol. 2016;5(1):5-14. doi: 10.1016/j.jbo.2015.11.002.
  60. Kong Y., Wang Y.T., Hu Y., Han W., Chang Y.J., Zhang X.H., Jiang Z.F., Huang X.J. The bone marrow microenvironment is similarly impaired in allogeneic hematopoietic stem cell transplantation patients with early and late poor graft function. Bone Marrow Transplant. 2016; 51(2):249-255. doi: 10.1038/bmt.2015.229.
  61. Glennie R.A., Rampersaud Y.R., Boriani S., Reynolds J.J., Williams R., Gokaslan Z.L., Schmidt M.H., Varga P.P., Fisher C.G. A systematic review with consensus expert opinion of best reconstructive techniques after osseous en bloc spinal column tumor resection. Spine (Phila Pa 1976). 2016;41(Suppl 20):S205-S211.
  62. Балаев П.И., Борзунов Д.Ю. Возможности костной пластики по Г.А. Иллизарову в восстановительном лечении пациентов с первичными опухолями костей голени. Сибирский онкологический журнал. 2013;1(55):59-64. Balaev P.I., Borzunov D.Ju. [Possibilities of bone reconstruction according to G.A. Illizarov in the recovery treatment of patients with primary tumors of the lower leg]. Sibirskii onkologicheskii zhurnal [Siberian oncology journal]. 2013;1(55):59-64. (in Russian).
  63. Khira Y.M., Badawy H.A. Pedicled vascularized fibular graft with Ilizarov external fixator for reconstructing a large bone defect of the tibia after tumor resection. J Orthop Traumatol. 2013;14(2):91-100. doi: 10.1007/s10195-013-0225-3.
  64. Bus M.P., Dijkstra P.D., van de Sande M.A., Taminiau A.H., Schreuder H.W., Jutte P.C., van der Geest I.C., Schaap G.R., Bramer J.A. Intercalary allograft reconstructions following resection of primary bone tumors: a nationwide multicenter study. J Bone Joint Surg Am. 2014;96(4):e26. doi: 10.2106/JBJS.M.00655.
  65. Wu Z., Fu J., Wang Z., Li X., Li J., Pei Y. Three-dimensional virtual bone bank system for selecting massive bone allograft in orthopaedic oncology. Int Orthop. 2015; 39(6):1151-1158. doi: 10.1007/s00264-015-2719-5.
  66. Горбатов Р.О., Нифтуллаев Р.М., Новиков А.Е. Прецизионные персонифицированные имплантаты для замещения костных дефектов при лечении пациентов с остеоонкологией. Современные проблемы науки и образования. 2016;(6):247. Gorbatov R.O., Niftullaev R.M., Novikov A.E. [Precision personalized implants to replace bone defects for treatment of patients with osteoonkology]. Sovremennye problemy nauki i obrazovaniya [Modern problems of science and education]. 2016;(6):247. (in Russian).
  67. Kang S., Han I., Hong S.H., Cho H.S., Kim W., Kim H.S. The MRI appearances of cancellous allograft bone chips after the excision of bone tumours. Bone Joint J. 2015; 97-B(1):121-128. doi: 10.1302/0301-620X.97B1.34517.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c)


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies