Non-invasive expandable prosthesis in musculoskeletal oncology paediatric patients for the distal and proximal femur. First results
Non-invasive expandable prosthesis in musculoskeletal oncology paediatric patients for the distal and proximal femur. First results
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DOI：
10.1007/s00264-016-3163-x
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发表时间：
2016-08-01
影响因子：
2.7
通讯作者：
Knorr, Jorge
中科院分区：
文献类型：
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作者：
Torner, Ferran;Segur, Josep M.;Knorr, Jorge
目的：无创性可扩张假体用于肿瘤切除后的保肢手术。本研究的目的是评估这种治疗的有效性。方法7例儿童股骨肿瘤切除和保肢与非骨水泥非侵入性增长假体。手术时的平均年龄为9.8岁（范围8-12岁）。股骨远端骨肉瘤6例，股骨近端尤文肉瘤1例。6例全膝关节假体在原发性肿瘤切除术时植入，1例双极髋关节假体是骨关节同种异体移植失败的翻修术。功能结果和情绪接受使用MSTS score.Results的平均随访时间为65.3个月（范围29-91）个月进行了评估。2例死于肺转移，无局部复发。平均股骨切除18厘米（范围17-19）的膝盖，和24厘米的髋关节。平均总扩张为36.4 mm（范围12.3-63.5）。康复后平均MSTS评分为26.3（范围21-29）。有1例延长器械失效，1例晚期感染，1例患者因盆腔转移需要髂股旁路移植术。结论非侵入性可膨胀假体减少了最终的肢体长度的差异，在成长的患者与可接受的功能，似乎有优势相比，侵入性可膨胀假体，需要多次手术，但并发症发生率仍然很高。
Purpose The non-invasive expandable prosthesis for skeletally immature patients is used after limb salvage surgery following tumor resection. The aim of the study was to assess the effectiveness of this treatment.Methods Seven paediatric patients with femoral tumors had resection and limb salvage with an uncemented non-invasive growing prosthesis. Mean age at the time of surgery was 9.8 (range 8-12) years. There were six distal femur osteosarcomas and one proximal femur Ewing sarcoma. Six total knee prosthesis were implanted at the time of primary tumor resection and one bipolar hip prosthesis was a revision from a failed osteoarticular hip allograft. Functional outcomes and emotional acceptance were assessed using the MSTS score.Results The mean follow-up was 65.3 months (range 29-91) months. Two patients died of pulmonary metastasis and there was no local recurrence. The mean femoral resection was 18 cm (range 17-19) on the knee, and 24 cm on the hip. Mean total expansion was 36.4 mm (range 12.3-63.5). The mean MSTS score after rehabilitation was 26.3 (range 21-29). There was one lengthening device failure, one late infection and one patient who required iliofemoral bypass grafting surgery for a pelvic metastasis. No local recurrence occurred.Conclusions The non-invasive expandable prosthesis reduces the final limb-length discrepancy in growing patients with an acceptable function and appears to have an advantage as compared to invasive expandable prostheses which require multiple surgical procedures, but the complications rate is still high.