Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis
Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis
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DOI：
10.2106/jbjs.f.01324
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发表时间：
2008-06-01
影响因子：
5.3
通讯作者：
Abudu, A.
中科院分区：
文献类型：
--
作者：
Jeys, L. M.;Kulkarni, A.;Abudu, A.
背景：如果优先考虑保肢，骨肿瘤切除后需要重建。在我们的单位，使用内假体植入物重建是首选，因为患者通常可以迅速恢复完全负重和功能活动。长期并发症，如深部感染、无菌性松动和植入物的机械失效，导致人们对重建的有效性以及在长期保留肢体的同时翻修失效植入物的能力表示担忧。本研究的目的是调查的生存endoprosthetic重建在中期至长期，以确定其failure.Methods相关的因素：一个连续的系列776例患者进行endoprosthetic重建骨肿瘤切除术后，在最低的10年前，这项调查。排除了109名植入了所谓的生长型内假体的儿童，因为他们通常需要在骨骼成熟时对成人假体进行翻修。由于缺乏足够的随访数据，6例患者被排除，留下661例患者进行分析。Kaplan-Meier生存分析的植入物进行，与植入物的任何原因（感染，局部复发，机械故障），机械故障单独修订，截肢作为endpoints.Results：随访的平均持续时间为15年的患者生存的原始疾病。227例患者（34%）因机械故障（116例患者）、感染（75例患者）和局部复发性疾病（36例患者）接受翻修手术。以机械失效为终点的10年植入物存活率为75%，以任何原因失效为终点的10年植入物存活率为58%。20年的保肢率为84%.Conclusions：我们相信第一代内假体的中长期结果是令人鼓舞的，并证明了骨肿瘤切除后继续使用内假体进行重建的合理性。证据等级：治疗等级IV。证据等级的完整描述见作者说明。
Background: Excision of a bone tumor requires reconstruction if limb salvage is a priority. Reconstruction with an endoprosthetic implant is preferred in our unit, as the patient typically can return rapidly to full weight-bearing and functional activities. Long-term complications, such as deep infection, aseptic loosening, and mechanical failure of the implants, have led to concerns about the efficacy of reconstruction and the ability to revise failed implants while maintaining limb salvage in the longer term. The purpose of this study was to investigate the survival of endoprosthetic reconstructions in the medium to long term in order to determine the factors associated with their failure.Methods: A consecutive series of 776 patients underwent endoprosthetic reconstruction following resection of a bone tumor at a minimum of ten years prior to this investigation. One hundred and nine children with a so-called growing endoprosthesis were excluded as they often require revision to an adult prosthesis near skeletal maturity. Six patients were excluded because of a lack of adequate follow-up data, leaving 661 patients for analysis. Kaplan-Meier survival analysis of the implant was performed, with implant revision for any cause (infection, local recurrence, and mechanical failure), mechanical failure alone, and amputation used as the end points.Results: The mean duration of follow-up was fifteen years for patients who survived the original disease. Two hundred and twenty-seven patients (34%) had revision surgery because of mechanical failure (116 patients), infection (seventy-five patients), and locally recurrent disease (thirty-six patients). Implant survival at ten years was 75% with mechanical failure as the end point and 58% with failure from any cause as the end point. The limb salvage rate was 84% at twenty years.Conclusions: We believe these medium to long-term results with first-generation endoprostheses are encouraging and justify the continued use of endoprostheses for reconstruction following the excision of a bone tumor.Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.