Medium to Long-Term Results After Reconstruction of Bone Defects at the Knee With Tumor Endoprostheses
Medium to Long-Term Results After Reconstruction of Bone Defects at the Knee With Tumor Endoprostheses
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DOI：
10.1002/jso.21441
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发表时间：
2010-02-01
影响因子：
2.5
通讯作者：
Heisel, C.
中科院分区：
文献类型：
--
作者：
Kinkel, S.;Lehner, B.;Heisel, C.
背景和目的：保肢和肿瘤内假体重建被认为是治疗膝关节骨缺损的标准。迄今为止，很少有研究报告长期结果。方法：对 77 名植入非骨水泥或骨水泥 MUTARS (R) 内置假体的患者进行了平均 46 个月（3-128 个月）的随访。缺陷原因为原发肿瘤病变 69 例，转移灶 8 例。股骨远端 (n=49) 或胫骨近端 (n=28) 主要采用非骨水泥植入物重建（股骨：695，胫骨：92%）。关节内肿瘤切除术46例，关节外肿瘤切除术31例。结果：10年后保肢概率为92%，复发率为3%。并发症频繁发生，翻修率为 58%，最初植入的假体 5 年后累积生存概率为 57%。锁定机构失效（n=15）和无菌性松动（n=13）是最常见的失效模式。结论：尽管实现了低复发率和令人满意的功能结果，但我们发现巨型假体植入后并发症发生率很高。这对于关节外切除和骨水泥固定尤其明显，应尽可能避免。 J.外科医生。安科尔。 2010：101：106-169。 (C) 2009 Wiley-Liss, Inc.
Background and Objectives: Limb salvage and reconstruction with tumor endoprostheses is considered as therapeutic standard in the treatment of bone defects at the knee. Few studies report long-term results so far.Methods: Seventy-seven patients who had a cementless or cemented MUTARS (R) endoprosthesis implanted were followed-up for a mean period of 46 months (3-128 months). The defects were due to primary tumor lesions in 69 cases or metastases in 8 cases. The distal femur (n=49) or the proximal tibia (n=28) was reconstructed predominantly with cementless implants (femur: 695, tibia: 92%). The resection of the tumor was intraarticular in 46 and extraarticular in 31 patients.Results: After 10 years probability of limb salvage was 92% with a recurrence rate of 3%. Complications were frequent with a revision rate of 58% and lead to a cumulative probability of survival of the initially implanted prosthesis of 57% after 5 years. Locking mechanism failure (n=15) and aseptic loosening (n=13) were the most frequent failure modes.Conclusions: Regardless of achieving a low recurrence rate and satisfactory functional results, we found a high complication rate after implantation of a megaprosthesis. This was particularly evident for extraarticular resections and cemented fixation, which should be avoided when possible. J. surg. Oncol. 2010:101:106-169. (C) 2009 Wiley-Liss, Inc.