The long-term results of endoprosthetic replacement of the proximal tibia for bone tumours
The long-term results of endoprosthetic replacement of the proximal tibia for bone tumours
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DOI：
10.1302/0301-620x.89b12.19481
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发表时间：
2007-12-01
影响因子：
--
通讯作者：
Grimer, R. J.
中科院分区：
文献类型：
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作者：
Myers, G. J. C.;Abudu, A. T.;Grimer, R. J.
我们研究了设计的改进是否改变了肿瘤切除后接受胫骨近端假体置换术的患者的结局。使用前瞻性数据库记录了植入物的存活率和“维修”过程。共有194例患者接受了近端胫骨置换术，其中95例采用固定铰链设计，99例采用羟基磷灰石颈环固定铰链设计;他们的中位年龄为21.5岁（10 - 74岁）。平均随访14.7年（5 - 29年），115例患者仍然存活。在固定铰链组中，任何原因导致的翻修风险在5年时为32%，10年时为61%，15年和20年时为75%，而在固定铰链组中，5年时为12%，10年时为25%，15年时为30%。无菌性松动是固定铰链膝关节翻修的最常见原因，旋转铰链膝关节早期设计中植入物断裂和当前版本中感染是最常见原因。在10年时，固定铰链膝关节的无菌性松动翻修风险为46%。在使用羟基磷灰石领的双铰链膝关节中，这一比例降至3%。骨水泥型旋转铰链设计目前为假体的长期生存提供了最佳机会。
We have investigated whether improvements in design have altered the outcome for patients undergoing endoprosthetic replacement of the proximal tibia following resection of a tumour. Survival of the implant and 'servicing' procedures have been documented using a prospective database.A total of 194 patients underwent a proximal tibial replacement, with 95 having a fixed-hinge design and 99 a rotating-hinge with a hydroxyapatite collar; their median age was 21.5 years (10 to 74). At a mean follow-up of 14.7 years (5 to 29), 115 patients remain alive. The risk of revision for any reason in the fixed-hinge group was 32% at five years, 61% at ten years and 75% at 15 and 20 years, and in the rotating-hinge group 12% at five years, 25% at ten years and 30% at 15 years. Aseptic loosening was the most common reason for revision in the fixed-hinge knees, fracture of the implant in the early design of rotating hinges and infection in the current version. The risk of revision for aseptic loosening in the fixed-hinge knees was 46% at ten years. This was reduced to 3% in the rotating-hinge knee with a hydroxyapatite collar. The cemented, rotating hinge design currently offers the best chance of long-term survival of the prosthesis.