Allograft reconstruction of the humerus: Complications and revision surgery
Allograft reconstruction of the humerus: Complications and revision surgery
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DOI：
10.1002/jso.25309
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发表时间：
2019-03-01
影响因子：
2.5
通讯作者：
Lozano-Calderon, Santiago A.
中科院分区：
文献类型：
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作者：
Ogink, Paul T.;Teunissen, Frederik R.;Lozano-Calderon, Santiago A.
背景和目的肱骨切除后的同种异体移植物重建是许多人的首选，因为骨量恢复和韧带和肌肉的生物附着到同种异体移植物，理论上获得优越的上级稳定性和功能。我们的目的是评估肱骨同种异体移植重建中并发症的发生率以及翻修手术的发生率和病因。方法我们纳入了1990年至2013年期间在我们机构接受肱骨广泛切除和同种异体骨移植重建原发性和转移性病变的18岁及以上患者。我们的主要结局指标是并发症和翻修手术。我们使用竞争风险回归来评估同种异体移植物存活率。结果在我们纳入的84例患者中，47例（51%）患者接受了肱骨近端、30例（36%）肱骨间和7例（8%）肱骨远端的同种异体骨重建。51例患者（61%）术后至少发生1例并发症。18例患者（21%）接受了翻修手术。5年移植物存活率为71%。结论：尽管同种异体肱骨重建术是骨科肿瘤医生的一个有价值的选择，但外科医生应注意并发症的发生率。同种异体移植物骨折似乎是近端和远端同种异体移植物的主要问题，通常导致翻修手术。同种异体骨间移植物常发生骨不连。
Background and Objectives Allograft reconstruction of the humerus after resection is preferred by many because of bone stock restoration and biologic attachment of ligaments and muscles to the allograft, theoretically obtaining superior stability and functionality. Our aim was to assess the prevalence of complications and the incidence and etiology for revision surgery in humeral allograft reconstructions. Methods We included patients 18 years and older who underwent wide resection and allograft reconstruction of the humerus for primary and metastatic lesions at our institution between 1990 and 2013. Our primary outcome measures were complications and revision surgery. We used competing risk regression to assess allograft survival. Results Of the 84 patients we included, 47 patients (51%) underwent allograft reconstructions of the proximal humerus, 30 (36%) intercalary, and seven (8%) of the distal humerus. Fifty-one patients (61%) had at least one complication after surgery. Eighteen patients (21%) underwent revision surgery. The 5-year allograft survival was 71%. Conclusion Although allograft reconstructions of the humerus are a valuable option in the orthopedic oncologist's armamentarium, surgeons should mind the accompanying complication rates. Allograft fractures seem to be the main issue for proximal and distal allografts, often leading to revision surgery. Intercalary allografts are mostly troubled by nonunions.