Minimising aseptic loosening in extreme bone resections CUSTOM-MADE TUMOUR ENDOPROSTHESES WITH SHORT MEDULLARY STEMS AND EXTRA-CORTICAL PLATES
Minimising aseptic loosening in extreme bone resections CUSTOM-MADE TUMOUR ENDOPROSTHESES WITH SHORT MEDULLARY STEMS AND EXTRA-CORTICAL PLATES
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DOI：
10.1302/0301-620x.99b12.bjj-2017-0213.r1
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发表时间：
2017-12-01
影响因子：
4.6
通讯作者：
Jeys, L.
中科院分区：
文献类型：
--
作者：
Stevenson, J. D.;Wigley, C.;Jeys, L.
目的在肿瘤治疗中切除大量骨后，剩余骨段可能不足以接受标准长度的髓内骨水泥型股骨柄。短柄假体无菌性松动的风险增加。增加了皮质外接骨板，以通过补充固定来最大限度地降低这种风险。本研究的目的是调查短柄endoprostheses和extra-cortical plates.Patients and MethodsThe study involves 37 patients who received limb salvage surgery for a primary neoplasm of bone between 1998 and 2013.肱骨近端置换9例，股骨近端置换9例，股骨远端置换13例，胫骨近端置换6例。有12例初次手术（32%）和25例翻修手术（68%）。将种植体存活率与匹配对照进行比较。被切除的骨的量是> 70%，其长度和统计学大于标准对照组在每个解剖situation.ResultsThe平均随访7年（1至17）。肱骨柄的平均长度为33 mm（20 - 60），下肢柄的平均长度为79 mm（34 - 100）。根据解剖部位对植入物存活率进行的Kaplan-Meier分析证实，在肱骨近端，短柄内假体和标准柄对照之间没有统计学显著差异（p = 0.84），股骨近端（p = 0.57），股骨远端（p = 0.21）和胫骨近端（p = 0.61）个部位。在短柄组中，在平均8.5年（范围2 - 16年）时，没有皮质外板骨结合的种植体发生松动。三个十（30%）无骨整合遭受无菌性松动，平均为7.7年（范围2至11.5年）。ConclusionWhen广泛切除骨需要在手术治疗的肿瘤，并在修订的情况下，除了额外的皮质板短髓干已显示出非劣效性标准长度髓干和最大限度地减少无菌性失败。
AimsFollowing the resection of an extensive amount of bone in the treatment of a tumour, the residual segment may be insufficient to accept a standard length intramedullary cemented stem. Short-stemmed endoprostheses conceivably have an increased risk of aseptic loosening. Extra-cortical plates have been added to minimise this risk by supplementing fixation. The aim of this study was to investigate the survivorship of short-stemmed endoprostheses and extra-cortical plates.Patients and MethodsThe study involved 37 patients who underwent limb salvage surgery for a primary neoplasm of bone between 1998 and 2013. Endoprosthetic replacement involved the proximal humerus in nine, the proximal femur in nine, the distal femur in 13 and the proximal tibia in six patients. There were 12 primary (32%) and 25 revision procedures (68%). Implant survivorship was compared with matched controls. The amount of bone that was resected was > 70% of its length and statistically greater than the standard control group at each anatomical site.ResultsThe mean follow-up was seven years (one to 17). The mean length of the stem was 33 mm (20 to 60) in the humerus and 79 mm (34 to 100) in the lower limb. Kaplan-Meier analysis of survival of the implant according to anatomical site confirmed that there was no statistically significant difference between the short-stemmed endoprostheses and the standard stemmed controls at the proximal humeral (p = 0.84), proximal femoral (p = 0.57), distal femoral (p = 0.21) and proximal tibial (p = 0.61) sites.In the short-stemmed group, no implants with extra-cortical plate osseointegration suffered loosening at a mean of 8.5 years (range 2 to 16 years). Three of ten (30%) without osseointegration suffered aseptic loosening at a mean of 7.7 years (range 2 to 11.5 years).ConclusionWhen extensive resections of bone are required in the surgical management of tumours, and in revision cases, the addition of extra-cortical plates to short medullary stems has shown non-inferiority to standard length medullary stems and minimises aseptic failure.