Muscolo D Luis, Ayerza Miguel A, Aponte-Tinao Luis A, Ranalletta Maximiliano
Institute of Orthopedics Carlos E. Ottolenghi, Italian Hospital of Buenos Aires, Potosí 4215, 1199, Buenos Aires, Argentina.
J Bone Joint Surg Am. 2006 Sep;88 Suppl 1 Pt 2:305-21. doi: 10.2106/jbjs.f.00324.
As diagnostic and therapeutic techniques improve, patients with a musculoskeletal sarcoma should expect longer survival, fewer complications and side effects, and an improved quality of life. Functional longevity of the reconstruction after resection of the tumor becomes a major concern, especially in young and physically active patients. The purpose of this study was to analyze the mid-term and long-term survival of reconstructions with a distal femoral osteoarticular allograft in a series of patients.
We retrospectively reviewed the results of eighty reconstructions with a distal femoral osteoarticular allograft following resection of a bone tumor in seventy-six patients. The mean duration of follow-up was eighty-two months. The rates of survival of the allograft and the joint surface were estimated with use of the Kaplan-Meier method. Cox regression analysis was performed to determine whether age, gender, the percentage of the femur that had been resected, and the use of chemotherapy were independent prognostic factors. Functional and radiographic results were documented according to the Musculoskeletal Tumor Society scoring system at the time of the latest follow-up.
Five patients were lost to follow-up, leaving seventy-five allografts in seventy-one patients available for study. Thirteen patients (thirteen allografts) died of tumor-related causes without allograft failure before a two-year radiographic follow-up could be performed. Of the remaining sixty-two allografts, fourteen failed: six failed as a result of infection; four, because of local recurrence; one, because of massive resorption; and three, as a result of fracture. At the time of final follow-up, at a mean of 125 months, forty-eight allografts were still in place. The overall rate of allograft survival was 78% at both five and ten years, and the rate of allograft survival without the need for resurfacing with a knee prosthesis was 71% at both five and ten years. With the numbers available, age, gender, the percentage of the femur that had been resected, and the use of chemotherapy were not found to have a significant effect on the overall allograft survival rates. The patients who retained the original allograft had good or excellent functional and radiographic results.
The life expectancy for most patients with a highly aggressive or malignant tumor in the distal part of the femur is now several decades. In this study, we found a high rate of survival of distal femoral allograft reconstructions at both five and ten years.
随着诊断和治疗技术的进步，肌肉骨骼肉瘤患者有望获得更长的生存期、更少的并发症和副作用以及更高的生活质量。肿瘤切除术后重建的功能持久性成为主要关注点，尤其是在年轻且身体活跃的患者中。本研究的目的是分析一系列患者中采用远端股骨骨关节异体移植进行重建的中期和长期生存率。
我们回顾性分析了76例患者在切除骨肿瘤后采用远端股骨骨关节异体移植进行的80次重建结果。平均随访时间为82个月。采用Kaplan-Meier法估计异体移植和关节面的生存率。进行Cox回归分析以确定年龄、性别、股骨切除百分比以及化疗的使用是否为独立的预后因素。在最近一次随访时，根据肌肉骨骼肿瘤学会评分系统记录功能和影像学结果。
5例患者失访，71例患者中的75次异体移植可供研究。13例患者（13次异体移植）在进行两年影像学随访前死于肿瘤相关原因，而异体移植未失败。在其余62次异体移植中，14次失败：6次因感染失败；4次因局部复发；1次因大量吸收；3次因骨折。在最终随访时，平均125个月，48次异体移植仍在位。5年和10年时异体移植的总体生存率均为78%，5年和10年时无需用膝关节假体翻修的异体移植生存率均为71%。就现有数据而言，年龄、性别、股骨切除百分比以及化疗的使用对异体移植总体生存率无显著影响。保留原始异体移植的患者功能和影像学结果良好或优异。
目前大多数股骨远端高度侵袭性或恶性肿瘤患者的预期寿命为几十年。在本研究中，我们发现5年和10年时远端股骨异体移植重建的生存率很高。
