Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur - Medium to long-term results
Prosthetic knee replacement after resection of a malignant tumor of the distal part of the femur - Medium to long-term results
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DOI：
10.2106/00004623-199805000-00004
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发表时间：
1998-05-01
影响因子：
5.3
通讯作者：
Healey, JH
中科院分区：
文献类型：
--
作者：
Kawai, A;Muschler, GF;Healey, JH
在连续40例患者中，我们评估了广泛切除股骨远端原发恶性肿瘤后定制人工膝关节置换术的中长期疗效。随访时间从5年到17年不等(中位数为8年)。在最近一次随访时，40名患者中35名(88%)无病，5名(13%)存活，均为转移性疾病。未见局部复发。18例患者出现20例早期并发症(45%)。股骨假体无菌性松动是最常见的失败模式，需要11名患者平均51个月进行翻修。使用Kaplan-Meier方法估计的假体存活率在三年、五年和十年分别为85%、67%和48%。单变量分析显示，男性患者的假体存活率明显更差，对于那些股骨至少40%被切除的患者，那些接受股四头肌全切或次全切除(仅保留股直肌)的患者，以及那些使用直股骨柄的患者(P<；0.05，所有比较)。多因素分析显示，影响假体存活的独立不良预后因素是男性、切除至少40%的股骨、股骨柄用骨水泥固定。采用Kaplan-Meier法计算保肢率，3年为93%，5年和10年为90%，最近一次随访时，按肌肉骨骼肿瘤学会的分类系统，功能评分为14~29分，平均为24分，相当于正常功能的80%。保留股四头肌的患者在行走支撑力和步态类别上的平均得分好于那些接受肌肉全切除或次全切除的患者。尽管成像和局部治疗的进步缩小了特纳关节外切除的适应证，但本研究中使用的植入物仍在大约15%的骨折或肿瘤关节内延伸需要广泛关节外切除的患者中使用。
We evaluated the medium to long-term results of treatment with a custom prosthetic knee replacement after wide resection of a primary malignant tumor of the distal part of the femur in forty consecutive patients. The duration of follow-up ranged from five to seventeen years (median, eight years). At the time of the latest follow-up, thirty-five (88 per cent) of the forty patients were free of disease and five (13 per cent) were alive,vith metastatic disease. No local recurrence was observed. Twenty early complications occurred in eighteen patients (45 per cent). Aseptic loosening of the femoral component, which necessitated a revision in eleven patients at an average of fifty-one months, was the most frequent mode of failure. The rate of prosthetic survival, as estimated with use of the Kaplan-Meier method, was 85, 67, and 48 per cent at three, five, and ten years. Univariate analysis demonstrated that the rate of prosthetic survival was significantly worse for male patients, for those in whom at least 40 per cent of the femur had been resected, for those who had had total resection of the quadriceps muscles or subtotal resection (preservation of only the rectus femoris muscle), and for those in whom a straight femoral stem had been used (p < 0.05 for all comparisons). Multivariate analysis showed that the independent adverse prognostic factors for prosthetic survival were male gender, resection of at least 40 per cent of the femur, and fixation of the femoral stem with cement. The rate of limb salvage was calculated, with use of the Kaplan-Meier method, to be 93 per cent at three years and 90 per cent at five and ten years.At the latest follow-up examination, the functional scores according to the classification system of the Musculoskeletal Tumor Society ranged from 14 to 29 points; the mean was 24 points, which represents function that is 80 per cent that of normal. The mean scores in the categories of walking supports and gait were better for the patients in whom the quadriceps muscles had been preserved than for those who had had total or subtotal resection of those muscles.Although advances in imaging and local therapy narrow the indications for an extra-articular resection of a turner, the implant that was used in the present study continues to be used in approximately 15 per cent of patients who have a fracture or an intra-articular extension of the tumor that necessitates extensive extra-articular resection.