Poor Long-term Clinical Results of Saddle Prosthesis After Resection of Periacetabular Tumors
Poor Long-term Clinical Results of Saddle Prosthesis After Resection of Periacetabular Tumors
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DOI：
10.1007/s11999-012-2631-x
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发表时间：
2013-01-01
影响因子：
4.2
通讯作者：
Dijkstra, P. D. S.
中科院分区：
文献类型：
--
作者：
Jansen, J. A.;van de Sande, M. A. J.;Dijkstra, P. D. S.
鞍形假体最初是为了在髋关节翻修术中重建大的髋臼缺损而开发的，主要用于髋臼周围肿瘤切除术后的髋关节重建。这些重建的长期生存率尚不清楚。因此，我们检查了髋臼周围肿瘤切除术后使用鞍式假体治疗的患者的长期功能、并发症和生存率。1987年至2003年间，我们在髋臼周围肿瘤切除术后使用鞍式假体治疗了17名患者（12例软骨肉瘤、3例骨肉瘤、1例恶性纤维组织细胞瘤、1例转移瘤）。随访期间，11例患者死亡，中位总生存期为49个月（95% CI，30-68个月）。其余6例患者均存活，无疾病（平均随访12.1年;范围8.3-16.8年）。1例患者在3个月后因脱位和感染取出鞍形假体。我们获得了SF-36问卷、多伦多残疾救助评分（TESS）和肌肉骨骼肿瘤协会（MSTS）评分。17例患者中有13例在末次随访时使用助行器进行活动：8例患者需要两支拐杖，5例需要一支拐杖，1例未使用任何助行器。其他3名患者无法独立活动，只能从床到椅子转移。末次随访时，6例存活患者的平均髋关节屈曲度为60 A度（范围：40 A度-100 A度）。17例患者中有14例出现局部并发症：9例伤口感染，7例脱位，2例下肢长度差异需要额外手术。在5名存活的患者中，他们的首次手术假体仍在原位，长期随访时的平均MSTS评分为47%。（范围，20%-77%），平均TESS评分为53%（范围，41%-67%），平均SF-36身体和精神组成部分综合评分为43.9和50.6，髋臼周围肿瘤手术后使用鞍形假体重建具有较高的并发症风险和髋关节屈曲受限的长期功能差;因此，我们不再使用鞍形假体进行髋臼周围肿瘤切除后的重建。IV级，回顾性病例系列。有关证据等级的完整描述，请参见作者指南。
The saddle prosthesis originally was developed to reconstruct large acetabular defects in revision hip arthroplasty and was used primarily for hip reconstruction after periacetabular tumor resections. The long-term survival of these reconstructions is unclear.We therefore examined the long-term function, complications, and survival in patients treated with saddle prostheses after periacetabular tumor resection.Between 1987 and 2003 we treated 17 patients with a saddle prosthesis after periacetabular tumor resection (12 chondrosarcomas, three osteosarcomas, one malignant fibrous histiocytoma, one metastasis). During followup, 11 patients died, resulting in a median overall survival of 49 months (95% CI, 30-68 months). The remaining six patients were alive without disease (mean followup, 12.1 years; range, 8.3-16.8 years). In one patient the saddle prosthesis was removed after 3 months owing to dislocation and infection. We obtained SF-36 questionnaires, Toronto Extremity Salvage Scores (TESS), and Musculoskeletal Tumor Society (MSTS) scores.Thirteen of 17 patients used walking assists for mobilization at last followup: eight patients required two crutches, five needed one crutch, and one did not use any walking aids. The other three patients were not able to mobilize independently and only made bed to chair transfers. The mean hip flexion in the six surviving patients was 60A degrees (range, 40A degrees-100A degrees) at last followup. Local complications were seen in 14 of the 17 patients: nine wound infections, seven dislocations, and two leg-length discrepancies requiring additional surgery. In the five surviving patients with their index prosthesis still in situ, the mean MSTS score at long-term followup was 47% (range, 20%-77%), the mean TESS score was 53% (range, 41%-67%), and the mean composite SF-36 physical and mental component summaries were 43.9 and 50.6, respectively.Reconstruction with saddle prostheses after periacetabular tumor surgery has a high risk of complications and poor long-term function with limited hip flexion; therefore, we no longer use the saddle prosthesis for reconstruction after periacetabular tumor resections.Level IV, retrospective case series. See the Guideline for Authors for a complete description of levels of evidence.